Factors Influencing Further Acupuncture Usage and a More Positive Outcome in Patients With Osteoarthritis of the Knee and the Hip: A 3-Year Follow-up of a Randomized Pragmatic Trial Practice, practitioner, or placebo? A multifactorial, mixed-methods randomized controlled trial of acupuncture Effectiveness of moxibustion treatment as adjunctive therapy in osteoarthritis of the knee: a randomized, double-blinded, placebo-controlled clinical trial A Blinded Randomised Trial of Acupuncture (Manual and Electroacupuncture) Compared with a Non-Penetrating Sham for the Symptoms of Osteoarthritis of the Knee The Effect of Acupuncture on the Symptoms of Knee Osteoarthritis - An Open Randomised Controlled Study The integrated response of the human cerebro-cerebellar and limbic systems to acupuncture stimulation at ST 36 as evidenced by fMRI Treatment of cervical spondylosis. Electroacupuncture versus physiotherapy. Efficacy of periosteal stimulation for chronic pain associated with advanced knee osteoarthritis: a randomized, controlled clinical trial. Randomized trials published in some Chinese journals: how many are randomized? A randomized trial of acupuncture as an adjunctive therapy in osteoarthritis of the knee. Acupuncture in patients with osteoarthritis of the knee: a randomised trial Moxibustion Treatment for Knee Osteoarthritis: A Multi-Centre, Non-Blinded, Randomised Controlled Trial on the Effectiveness and Safety of the Moxibustion Treatment versus Usual Care in Knee Osteoarthritis Patients [Observation on clinical effects of moxibustion stimulation of different sensitive status acupoints for knee osteoarthritis]. Severe knee osteoarthritis: a randomized controlled trial of acupuncture, physiotherapy (supervised exercise) and standard management for patients awaiting knee replacement. A pilot study on using acupuncture and transcutaneous electrical nerve stimulation (TENS) to treat knee osteoarthritis (OA) Effectiveness of Acupuncture as Adjunctive Therapy in Osteoarthritis of the Knee [Randomized controlled study on the treatment of knee osteoarthritis with different acupuncture methods at different stages]. Interpretive Bias in Acupuncture Research? Safety of Acupuncture: Results of a Prospective Observational Study with 229,230 Patients and Introduction of a Medical Information and Consent Form [Efficacy evaluation on knee osteoarthritis treated with acupuncture: non-randomized concurrent control trial]. Acupuncture for chronic knee pain: a randomized clinical trial. Sham device v inert pill: randomised controlled trial of two placebo treatments [Clinical evaluation of stiletto needle for pain of knee osteoarthritis]. [Knee osteoarthritis treated with acupuncture at Neiguan (PC 6) and Taichong (LR 3)]. Efficacy and safety of acupuncture for chronic pain caused by gonarthrosis: A study protocol of an ongoing multi-centre randomised controlled clinical trial [ISRCTN27450856] Patient reports of adverse events associated with acupuncture treatment: a prospective national survey A Comparison of Acupuncture with Advice and Exercises on the Symptomatic Treatment of Osteoarthritis of the Hip – a Randomised Controlled Trial Electroacupuncture versus Diclofenac in symptomatic treatment of Osteoarthritis of the knee: a randomized controlled trial [Comparative observation on hip osteoarthritis treated with electroacupuncture and medication]. Comparison the effect of lateral wedge insole and acupuncture in medial compartment knee osteoarthritis: a randomized controlled trial. A comparative study of diazepam and acupuncture in patients with osteoarthritis pain: a placebo controlled study. Acupuncture for the treatment of pain of osteoarthritic knees. Components of placebo effect: randomised controlled trial in patients with irritable bowel syndrome [Clinical effect of different schemes of mild moxibustion for treatment of knee osteoarthritis]. [Efficacy observation on knee osteoarthritis treated with electroacupuncture and its influence on articular cartilage with T2 mapping]. [Observation on the long-term efficacy of knee osteoarthritis treated with warm needling and rehabilitation training]. Acupuncture Randomized Trials (ART) in Patients with Chronic Low Back Pain and Osteoarthritis of the Knee – Design and Protocols Heat-Sensitive Moxibustion in Patients with Osteoarthritis of the Knee: A Three-Armed Multicentre Randomised Active Control Trial Acupuncture treatment of severe knee osteoarthrosis. A long‐term study Validation study of WOMAC: a health status instrument for measuring clinically important patient relevant outcomes to antirheumatic drug therapy in patients with osteoarthritis of the hip or knee. [Effect of Acupuncture plus Different Frequency Shock-wave Interventions on Pain Reactions and Motor Function in Knee Osteoarthritis Patients]. [Clinical observation on fire needles at bones combined with cupping and Tuina for knee osteoarthritistis]. [Treatment of knee osteoarthritis with acupuncture and moxibustion: a randomized controlled trial]. A controlled study of acupuncture in neck pain. Electroacupuncture with different current intensities to treat knee osteoarthritis: a single-blinded controlled study. The York acupuncture safety study: prospective survey of 34 000 treatments by traditional acupuncturists Adverse events following acupuncture: prospective survey of 32 000 consultations with doctors and physiotherapists Trigger Point Acupuncture for Treatment of Knee Osteoarthritis – a Preliminary Rct for a Pragmatic Trial Immediate Effects of Electroacupuncture and Manual Acupuncture on Pain, Mobility and Muscle Strength in Patients with Knee Osteoarthritis: A Randomised Controlled Trial Short Term Reactions to Acupuncture – a Cross-Sectional Survey of Patient Reports [Observation on the efficacy of acupuncture and fire needle therapy for hand osteoarthritis]. Active albuterol or placebo, sham acupuncture, or no intervention in asthma. Acupuncture in patients with osteoarthritis of the knee or hip: a randomized, controlled trial with an additional nonrandomized arm. Introducing a placebo needle into acupuncture research Clinical decisions in the use of acupuncture as an adjunctive therapy for osteoarthritis of the knee. Integrating Acupuncture With Exercise-Based Physical Therapy for Knee Osteoarthritis: A Randomized Controlled Trial The effects of collateral meridian therapy for knee osteoarthritis pain management: a pilot study. [YANG's pricking-cupping therapy for knee osteoarthritis: a multi-center randomized controlled trial]. Evaluation of clinically relevant changes in patient reported outcomes in knee and hip osteoarthritis: the minimal clinically important improvement. Minimal clinically important rehabilitation effects in patients with osteoarthritis of the lower extremities. Acupuncture as an adjunct to exercise based physiotherapy for osteoarthritis of the knee: randomised controlled trial [Case-controll study on the synergistic effects of electroacupuncture on knee osteoarthritis after arthroscopic debridement]. Non-specific effects of traditional Chinese acupuncture in osteoarthritis of the hip. The acupuncture treatment of neck pain: a randomized controlled study. [Controlled observation of clinical efficacy on knee osteoarthritis treated with auricular electroacupuncture and the isolated moxibustion with Lingxian herbal paste]. Comparison Between Electro-Acupuncture and Hydrotherapy, Both in Combination With Patient Education and Patient Education Alone, on the Symptomatic Treatment of Osteoarthritis of the Hip
Objective : Considering the chronicity of osteoarthritis-associated pain , we aim ed to evaluate long-term outcome differences between patients who received immediate or delayed acupuncture in addition to usual care  , and to identify predictors for further acupuncture usage and a better long-term outcome . Material s and Methods : The Acupuncture in Routine Care study was an open-label r and omized pragmatic trial . As adjunct to  usual care  patients ( > 40 y , clinical and radiologic diagnosis of primary osteoarthritis of the knee or hip , pain duration > 6 mo ) received either immediate acupuncture in the first 3 months or delayed acupuncture in the subsequent 3 months . After 36 months 613 of 632 patients were available and asked to complete follow-up question naires . Primary outcome was the Western Ontario and McMaster Universities Osteoarthritis Index ( WOMAC ) . Results : A total of 500 ( 82 % ) of the contacted patients completed question naires . After 36 months the WOMAC Index did not differ significantly between groups ( immediate acupuncture 36.53±26.19 vs. delayed acupuncture 38.24±25.54 ; P=0.420 ) .  Further acupuncture  treatment during the follow-up period was reported by 202 patients and predicted by previous successful acupuncture treatment at baseline ( odds ratio=2.5 ; 95 % confidence interval , 1.6 - 3.9 ) . Less osteoarthritis symptoms ( WOMAC Index ) after 36 months were predicted by being an acupuncture responder at 6 months ( P<0.001 ) , having higher school education ( P=0.005 ) , not wanting to use medications ( P=0.016 ) , and using additional therapies ( P⩽0.001 to P=0.025 ) . Discussion : No long-term outcome differences were found between patients who received immediate versus those who received delayed acupuncture  treatment . Education level and additional therapies were identified as predictors for a better long-term outcome Summary This multifactorial mixed‐ methods r and omized controlled trial quantified the specific and nonspecific factors of acupuncture , and found that the practitioner , not the treatment , has the strongest effect on outcome . Abstract The nonspecific effects of acupuncture are well documented ; we wished to quantify these factors in osteoarthritic ( OA ) pain , examining needling , the consultation , and the practitioner . In a prospect i ve r and omised , single‐blind , placebo‐controlled , multifactorial , mixed‐ methods trial , 221 patients with OA awaiting joint replacement surgery were recruited . Interventions were acupuncture , Streitberger placebo acupuncture , and mock electrical stimulation , each with empathic or nonempathic consultations . Interventions involved eight 30‐minute treatments over 4 weeks . The primary outcome was pain ( VAS ) at 1 week posttreatment . Face‐to‐face qualitative interviews were conducted ( purposive sample , 27 participants ) . Improvements occurred from baseline for all interventions with no significant differences between real and placebo acupuncture ( mean difference −2.7 mm , 95 % confidence intervals −9.0 to 3.6 ; P = .40 ) or mock stimulation ( −3.9 , −10.4 to 2.7 ; P = .25 ) . Empathic consultations did not affect pain ( 3.0 mm , −2.2 to 8.2 ; P = .26 ) but practitioner 3 achieved greater analgesia than practitioner 2 ( 10.9 , 3.9 to 18.0 ; P = .002 ) . Qualitative analysis indicated that patients ’ beliefs about treatment veracity and confidence in outcomes were reciprocally linked . The supportive nature of the trial attenuated differences between the different consultation styles . Improvements occurred from baseline , but acupuncture has no specific efficacy over either placebo . The individual practitioner and the patient ’s belief had a significant effect on outcome . The 2 placebos  were equally as effective and credible as acupuncture . Needle and nonneedle placebos are equivalent . An unknown characteristic of the treating practitioner predicts outcome , as does the patient ’s belief ( independently ) . Beliefs about treatment veracity shape how patients self‐report outcome , complicating and confounding study interpretation Introduction Our objective was to compare the effectiveness and safety of traditional Chinese moxibustion to that of sham moxibustion in patients with chronic knee osteoarthritis ( KOA ) pain . Methods We conducted a r and omized placebo-controlled trial involving 110 patients with KOA who met the inclusion criteria . These patients r and omly received either active moxibustion ( n = 55 ) or sham moxibustion control ( n = 55 ) at acupoints Dubi ( ST 35 ) , extra-point Neixiyan ( EX-LE 4 ) , and an Ashi ( tender ) point three times a week for 6 weeks . Effects were evaluated with Western Ontario and McMaster Universities ’ Osteoarthritis Index ( WOMAC VA 3.1 ) criteria at the end of the course of treatment and 3 , 12 , and 24 weeks after the initial treatment . Results The WOMAC pain scores showed greater improvement in the active treatment group than in control at weeks 3 ( P = 0.012 ) , 6 ( P < 0.001 ) , 12 ( P = 0.002 ) , and 24 ( P = 0.002 ) as did WOMAC physical function scores of the active treatment group at week 3 ( P = 0.002 ) , 6 ( P = 0.015 ) , and 12 ( P < 0.001 ) but not 24 ( P = 0.058 ) . Patients and practitioners were blinded successfully , and no significant adverse effects were found during the trial . Conclusions A 6-week course of moxibustion seems to relieve pain effectively and improve function in patients with KOA for up to 18 weeks after the end of treatment . Moxibustion treatment appears to be safe , and the usefulness of the novel moxa device was vali date d . Trial registration Current controlled trial : IS RCT N68475405 . Registered 4 April 2014 Objectives To compare the effect of acupuncture ( manual and electroacupuncture ) with that of a non-penetrating sham ( ‘ placebo ’ needle ) in patients with osteoarthritic knee pain and disability who are blind to the treatment allocation . Methods Acupuncture naive patients with symptomatic and radiological evidence of osteoarthritis of the knee were r and omly allocated to a course of either acupuncture or non-penetrating sham acupuncture using a sheathed ‘ placebo ’ needle system . Acupuncture points for pain and stiffness were selected according to acupuncture theory for treating Bi syndrome . Both manual and electrical stimulation were used . Response was assessed using the WOMAC index for osteoarthritis of the knee , self reported pain scale , the EuroQol score and plasma β-endorphin . The effectiveness of blinding was assessed . Results There were 34 patients in each group . The primary end point was the change in WOMAC pain score after the course of treatment . Comparison between the two treatment groups found a significantly greater improvement with acupuncture ( mean difference 60 , 95 % CI 5 to 116 , P=0.035 ) than with sham . Within the acupuncture group there was a significant improvement in pain ( baseline 294 , mean change 95 , 95 % CI 60 to 130 , P<0.001 ) which was not seen by those who had sham acupuncture ( baseline 261 , mean change 35 , 95 % CI-10 to 80 , P=0.12 ) . Similar effects within group , but not between groups , were seen with the secondary end points of WOMAC stiffness , WOMAC function , and self reported pain . One month after treatment the between group pain difference had been lost ( mean difference 46 ; 95 % CI −9 to 100 , P=0.10 ) although the acupuncture group was still benefiting compared to baseline ( mean difference 59 ; 95 % CI 16 to 102 , P=0.009 ) . The EuroQol score , a generic measure of health related quality of life , was not altered by the treatments . A minority of patients correctly guessed their treatment group ( 41 % in the acupuncture group and 44 % in the control group ) . Plasma β-endorphin levels were not affected by either treatment . Conclusions Acupuncture gives symptomatic improvement for patients with osteoarthritis of the knee , and is significantly superior to non-penetrating sham acupuncture . The study did not confirm earlier reports of release of plasma β-endorphin during acupuncture Background Using an open r and omised controlled study , we examined the effectiveness of manual and electroacupuncture on symptom relief for patients with osteoarthritis of the knee . Methods Patients with symptomatic osteoarthritis of the knee were r and omised to one of three treatment groups . Group A had acupuncture alone , group B had acupuncture but continued on their symptomatic medication , and group C used their symptomatic medication for the first five weeks and then had a course of acupuncture added . Patients receiving acupuncture were treated twice weekly over five weeks . Needles were inserted ( with manual and electrical stimulation ) in acupuncture points for pain and stiffness , selected according to traditional acupuncture theory for treating Bi syndrome . Patients were assessed by a blinded observer before treatment , after five weeks ’ treatment and at one month follow up , using a visual analogue pain scale ( VAS ) and the Western Ontario McMaster ( WOMAC ) question naire for osteoarthritis of the knee . Results The 30 patients in our study were well matched for age , body mass index , disease duration , baseline VAS pain score and baseline WOMAC scores . Repeated measure analyses gave a highly significant improvement in pain ( VAS ) after the courses of acupuncture in groups A ( P=0.012 ) and B ( P=0.001 ) ; there was no change in group C until after the course of acupuncture , when the improvement was significant ( P=0.001 ) . Similarly significant changes were seen with the WOMAC pain and stiffness scores . These benefits were maintained during the one month after the course of acupuncture . Patients ’ rating of global assessment was higher than that of the acupuncturist . Conclusion We conclude that manual and electroacupuncture causes a significant improvement in the symptoms of osteoarthritis  of the knee , either on its own or as an adjunct therapy , with no loss of benefit after one month Clinical and experimental data indicate that most acupuncture clinical results are mediated by the central nervous system , but the specific effects of acupuncture on the human brain remain unclear . Even less is known about its effects on the cerebellum . This fMRI study demonstrated that manual acupuncture at ST 36 ( Stomach 36 , Zusanli ) , a main acupoint on the leg , modulated neural activity at multiple levels of the cerebro-cerebellar and limbic systems . The pattern of hemodynamic response depended on the psychophysical response to needle manipulation . Acupuncture stimulation typically elicited a composite of sensations termed deqi that is related to clinical efficacy according to traditional Chinese medicine . The limbic and paralimbic structures of cortical and subcortical regions in the telencephalon , diencephalon , brainstem and cerebellum demonstrated a concerted attenuation of signal intensity when the subjects experienced deqi . When deqi was mixed with sharp pain , the hemodynamic response was mixed , showing a predominance of signal increases instead . Tactile stimulation as control also elicited a predominance of signal increase in a subset of these regions . The study provides preliminary evidence for an integrated response of the human cerebro-cerebellar and limbic systems to acupuncture stimulation at ST 36 that correlates with the psychophysical response A prospect i ve , controlled clinical trial was undertaken to assess the relative efficacies of physiotherapy and electroacupuncture in the treatment of cervical spondylosis . The results suggested that , while both methods were effective , electroacupuncture produced an earlier symptomatic improvement with increased neck movement , especially in patients with mild degenerative changes of the cervical spine BACKGROUND Because of morbidity associated with painful knee osteoarthritis ( OA ) and commonly prescribed analgesics , patients often pursue complementary and alternative modalities ( eg , acupuncture ) . Clinical trials have demonstrated modest therapeutic efficacy of traditional Chinese acupuncture for knee OA pain , and patients with advanced disease have largely been excluded . We have previously demonstrated preliminary short-term tolerability and efficacy of periosteal stimulation therapy ( PST ) ( ie , electrical stimulation of the periosteum facilitated by acupuncture needles ) for older adults with advanced knee OA . OBJECTIVE This study evaluated the sustained efficacy of PST and boosters for treating chronic pain with advanced knee OA . METHODS One hundred ninety participants age > 50 years with Kellgren-Lawrence grade 3 or 4 knee OA and chronic pain were r and omized to ( 1 ) PST ( once a week for 10 weeks ) followed by PST boosters for 6 months ( once every 2 weeks 2 times , then once a month ) , ( 2 ) control PST ( ie , periosteal needles and brief electrical stimulation of control points ) once a week for 10 weeks , or ( 3 ) PST for 10 weeks followed by control PST boosters for 6 months . Change in the Western Ontario and McMaster Universities Osteoarthritis Index pain score immediately after the 10-week intervention and at 6-month follow-up ( 9 months after baseline ) was the primary outcome . OMERACT-OARSI ( Outcome Measures in Rheumatology Clinical Trials-Osteoarthritis Research Society International ) criteria also were evaluated . Secondary measures of outcome included ( 1 ) physical performance ( Short Physical Performance Battery , gait speed , Timed Up and Go , and timed stair climb ) ; ( 2 ) psychological factors ( depressive symptoms measured with the Center for Epidemiologic Studies -Depression scale , coping measured with the catastrophizing subscale of the Coping Strategies Question naire , and self-efficacy measured with the Arthritis Self-Efficacy Scale ) ; ( 3 ) health-related quality of life measured with the Medical Outcomes Study 36-Item Short-Form Health Survey ; ( 4 ) rescue pain medication use tracked with diaries ; and ( 5 ) health care utilization and interim physical activity were monitored via monthly telephone calls . RESULTS After adjustment for pain at baseline , the PST and control booster did not differ from controls at 10 weeks ( difference , 1.3 ; 95 % CI , -0.10 to 2.8 ; P = 0.0683 ) or 9 months ( difference , 1.1 ; 95 % CI , -0.32 to 2.6 ; P = 0.13 ) . The PST and PST booster group had similar improvement compared with controls at 10 weeks ( baseline adjusted difference , 1.1 ; 95 % CI , -0.34 to 2.5 ; P = 0.1369 ) but significantly more improvement at 9 months ( baseline adjusted difference , 1.5 ; 95 % CI , 0.069 to 3.0 ; P = 0.0401 ) . Baseline depressive symptoms , low self-efficacy , higher difficulty performing daily activities , and greater knee stiffness predicted a lower likelihood of response . CONCLUSION PST plus PST  boosters in patients age > 50 with advanced knee OA  were well-tolerated and modestly reduced pain . Clinical Trials.gov identifier : NCT00865046 Background The approximately 1100 medical journals now active in China are publishing a rapidly increasing number of research reports , including many studies identified by their authors as r and omized controlled trials . It has been noticed that these reports mostly present positive results , and their quality and authenticity have consequently been called into question . We investigated the adequacy of r and omization  of clinical trials published in recent years in China to determine how many of them met acceptable st and ards for allocating participants to treatment groups . Methods The China National Knowledge Infrastructure electronic data base was search ed for reports of r and omized controlled trials on 20 common diseases published from January 1994 to June 2005 . From this sample , a subset of trials that appeared to have used r and omization methods was selected . Twenty-one investigators trained in the relevant knowledge , communication skills and quality control issues interviewed the original authors of these trials about the participant r and omization methods and related quality -control features of their trials . Results From an initial sample of 37,313 articles identified in the China National Knowledge Infrastructure data base , we found 3137 apparent r and omized controlled trials . Of these , 1452 were studies of conventional medicine ( published in 411 journals ) and 1685 were studies of traditional Chinese medicine ( published in 352 journals ) . Interviews with the authors of 2235 of these reports revealed that only 207 studies adhered to accepted methodology for r and omization and could on those grounds be deemed authentic r and omized controlled trials ( 6.8 % , 95 % confidence interval 5.9–7.7 ) . There was no statistically significant difference in the rate of authenticity between r and omized controlled trials of traditional interventions and those of conventional interventions . R and omized controlled trials conducted at hospitals affiliated to medical universities were more likely to be authentic than trials conducted at level 3 and level 2 hospitals ( relative risk 1.58 , 95 % confidence interval 1.18–2.13 , and relative risk 14.42 , 95 % confidence interval 9.40–22.10 , respectively ) . The likelihood of authenticity was higher in level 3 hospitals than in level 2 hospitals ( relative risk 9.32 , 95 % confidence interval 5.83–14.89 ) . All r and omized controlled trials of pre-market drug clinical trial were authentic by our criteria . Of the trials conducted at university-affiliated hospitals , 56.3 % were authentic ( 95 % confidence interval 32.0–81.0 ) . Conclusion Most reports of r and omized controlled trials published in some Chinese journals lacked an adequate description of r and omization . Similarly , most so called ' r and omized controlled trials ' were not real r and omized controlled trials owing toa lack of adequate underst and ing on the part of the authors of rigorous clinical trial design . All r and omized controlled trials of pre-market drug clinical trial included in this research were authentic . R and omized controlled trials conducted by authors in high level hospitals , especially in hospitals affiliated to medical universities had a higher rate of authenticity . That so many non-r and omized controlled trials were published as r and omized controlled trials reflected the fact that peer review needs to be improved and a good practice guide for peer review including how to identify the authenticity of the study urgently needs to be developed OBJECTIVE The purpose of this study was to investigate the efficacy of acupuncture as an adjunctive therapy to st and ard care for the relief of pain and dysfunction in elderly patients with osteoarthritis ( OA ) of the knee . METHODS Seventy-three patients with symptomatic OA of the knee were r and omly assigned to treatment ( acupuncture ) or st and ard care ( control ) . Analysis was performed on last score carried forward to account for patients who dropped out before completion . Patients self-scored Western Ontario and McMaster Universities Osteoarthritis Index ( WOMAC ) and Lequesne indices at baseline and at 4 , 8 and 12 weeks . Patients in the control group were offered acupuncture treatment after 12 weeks . The data for these patients are pooled with those from the original acupuncture group for within-group analysis . RESULTS Patients r and omized to acupuncture improved on both WOMAC and Lequesne indices compared to those who received st and ard treatment alone . Significant differences on total WOMAC Scale were seen at 4 and 8 weeks . There appears to be a slight decline in effect at 4 weeks after cessation of treatment ( 12 weeks after first treatment ) . No adverse effects of acupuncture were reported . CONCLUSION These data suggest that acupuncture is an effective and safe adjunctive therapy to conventional care for patients with OA of the knee BACKGROUND Acupuncture is widely used by patients with chronic pain although there is little evidence of its effectiveness . We investigated the efficacy of acupuncture compared with minimal acupuncture and with no acupuncture in patients with osteoarthritis of the knee . METHODS Patients with chronic osteoarthritis of the knee ( Kellgren grade < or = 2 ) were r and omly assigned to acupuncture ( n=150 ) , minimal acupuncture ( superficial needling at non-acupuncture points ; n=76 ) , or a waiting list control ( n=74 ) . Specialised physicians , in 28 outpatient centres , administered acupuncture and minimal acupuncture in 12 sessions over 8 weeks . Patients completed st and ard question naires at baseline and after 8 weeks , 26 weeks , and 52 weeks . The primary outcome was the Western Ontario and McMaster Universities Osteoarthritis ( WOMAC ) index at the end of week 8 ( adjusted for baseline score ) . All main analyses were by intention to treat . RESULTS 294 patients were enrolled from March 6 , 2002 , to January 17 , 2003 ; eight patients were lost to follow-up after r and omisation , but were included in the final analysis . The mean baseline-adjusted WOMAC index at week 8 was 26.9 ( SE 1.4 ) in the acupuncture group , 35.8 ( 1.9 ) in the minimal acupuncture group , and 49.6 ( 2.0 ) in the waiting list group ( treatment difference acupuncture vs minimal acupuncture -8.8 , [ 95 % CI -13.5 to -4.2 ] , p=0.0002 ; acupuncture vs waiting list -22.7 [ -27.5 to -17.9 ] , p<0.0001 ) . After 52 weeks the difference between the acupuncture and minimal acupuncture groups was no longer significant ( p=0.08 ) . INTERPRETATION After 8 weeks of treatment , pain and joint function are improved more with acupuncture than with minimal acupuncture or no acupuncture in patients with osteoarthritis of the knee . However , this benefit decreases over time Introduction This study tested the effectiveness of moxibustion on pain and function in chronic knee osteoarthritis ( KOA ) and evaluated safety . Methods A multi-centre , non-blinded , parallel-group , r and omised controlled trial compared moxibustion with usual care ( UC ) in KOA . 212 South Korean patients aged 40–70 were recruited from 2011–12 , stratified by mild ( Kellgren/Lawrence scale grade s 0/1 ) and moderate-severe KOA ( grade s 2/3/4 ) , and r and omly allocated to moxibustion  or UC  for four weeks . Moxibustion involved burning mugwort devices over acupuncture and Ashi points in affected knee(s ) . UC was allowed . Korean Western Ontario and McMaster Universities Question naire ( K-WOMAC ) , Short Form 36 Health Survey ( SF-36v2 ) , Beck Depression Inventory ( BDI ) , physical performance test , pain numeric rating scale ( NRS ) and adverse events were evaluated at 5 and 13 weeks . K-WOMAC global score at 5 weeks was the primary outcome . Results 102 patients ( 73 mild , 29 moderate-severe ) were allocated to moxibustion , 110 ( 77 mild , 33 moderate-severe ) to UC . K-WOMAC global score ( moxibustion 25.42+/−SD 19.26 , UC 33.60+/−17.91 , p<0.01 , effect size = 0.0477 ) , NRS ( moxibustion 44.77+/−22.73 , UC 56.23+/−17.71 , p<0.01 , effect size = 0.0073 ) and timed-st and test  ( moxibustion 24.79+/−9.76 , UC 25.24+/−8.84 , p = 0.0486 , effect size = 0.0021 ) were improved by moxibustion at 5 weeks . The primary outcome improved for mild but not moderate-severe KOA . At 13 weeks , moxibustion significantly improved the K-WOMAC global score and NRS .  Moxibustion  improved SF-36 physical component summary ( p = 0.0299 ) , bodily pain ( p = 0.0003 ) , physical functioning ( p = 0.0025 ) and social functioning ( p = 0.0418 ) at 5 weeks , with no difference in mental component summary at 5 and 13 weeks . BDI showed no difference ( p = 0.34 ) at 5 weeks . After 1158 moxibustion treatments , 121 adverse events included first ( n = 6 ) and second degree ( n = 113 ) burns , pruritus and fatigue ( n = 2 ) . Conclusions Moxibustion may improve pain , function and quality of life in KOA patients , but adverse events are common . Limitations included no sham control or blinding . Trial Registration Clinical Research Information Service ( CRIS ) OBJECTIVE To observe the clinical effect of moxibustion of different acupoints undergoing heat-sensitive state and resting state in the treatment of knee osteoarthritis ( KOA ) patients . METHODS A total of 60 cases of KOA patients were enrolled in the present trial . They were divided into heat-sensitive moxibustion ( heat-sensitive ) group and non-sensitive moxibustion group ( resting group ) . Moxibustion was applied to Neixiyan ( EX-LE 4 ) , Waixiyan ( i.e. Dubi , ST 35 ) and Heding ( EX-LE 2 ) for about 45 min , once daily for 20 days . The heat-sensitive state was evaluated according to the patient 's feeling . After moxibustion stimulation at the acupoint area , if the patient feels the heat penetrating from the skin surface to the deep tissue , or/ and extending peripherally around the moxibustion site , or/ and transmitting toward a certain direction , it is considered to be heat sensitization state . The therapeutic effect was evaluated by using visual analogue scale ( VAS ) for pain severity changes and by Guiding Principles for Clinical Trials of New Drugs of Chinese Materia Medica for evaluating functional activity of the knee-joint . RESULTS After 20 sessions of treatment and after a half year 's follow-up , the total integrated scores of VAS in the heat-sensitive group were all lower than those of the resting group ( P < 0.01 ) . Following 20 sessions of treatment , of the two 30 KOA patients in the heat-sensitive group and resting group , 14 ( 46.67 % ) and 5 ( 16.67 % ) experienced a marked improvement , 10 ( 33.33 % ) and 9 ( 30.00 % ) were effective , 6 ( 20.00 % ) and 16 ( 53.33 % ) were invalid , with the effective rates being 80.00 % and 46.67 , respectively . Half-year 's follow-up showed that the effective rates of the heat-sensitive group and resting group were 79.17 % ( 19/24 ) and 42.86 % ( 6/14 ) , respectively , suggesting a better therapeutic effect of heat-sensitive moxibustion . CONCLUSION The clinical n effect of heat-sensitive moxibustion is significantly superior to that of non-sensitive moxibustion in the treatment of KOA patients , being worthy of clinical application OBJECTIVE To evaluate the effects of st and ardized western acupuncture and physiotherapy on pain and functional ability in patients with severe osteoarthritic knee pain awaiting knee arthroplasty . METHODS Three-arm , assessor-blind , r and omized controlled trial . PARTICIPANTS 181 patients awaiting knee arthroplasty . INTERVENTIONS acupuncture for 6 weeks ; physiotherapy for 6 weeks ; st and ardized advice . MAIN OUTCOME MEASURES Oxford Knee Score question naire ( OKS ) ( primary ) ; 50 m timed walk , and duration of hospital stay following knee arthroplasty . RESULTS There was no baseline difference between groups . At 7 weeks , there was a 10 % reduction in OKS in the acupuncture group which was a significant difference between the acupuncture and the control group : Mean ( s.d . ) acupuncture 36.8 ( 7.20 ) ; physiotherapy 39.2 ( 8.22 ) ; control 40.3 ( 8.48 ) ( P = 0.0497 ) . These effects were no longer present at 12 weeks . There was a trend ( P = 0.0984 ) towards a shorter in-patient stay of 1 day for the physiotherapy group [ mean 6.50 days ( s.d . 2.0 ) ] compared with the acupuncture group [ mean 7.77 days ( s.d . 3.96 ) ] . CONCLUSIONS We have demonstrated that patients with severe knee osteoarthritis can achieve a short-term reduction in OKS when treated with acupuncture . However , we failed to demonstrate any other clinical ly or statically significant effects between the groups . Both interventions can be delivered effectively in an out-patient group setting at a district general hospital . Further study is needed to evaluate the combined effects of these treatments Background The present study tests whether a combined treatment of acupuncture and transcutaneous electrical nerve stimulation ( TENS ) is more effective than acupuncture or TENS alone for treating knee osteoarthritis ( OA ) . Methods Thirty-two patients with knee OA were r and omly allocated to four groups . The acupuncture group ( ACP ) received only acupuncture treatment at selected acupoints for knee pain ; the TENS group ( TENS ) received only TENS treatment at pain areas ; the acupuncture and TENS group ( A&T ) received both acupuncture and TENS treatments ; the control group ( CT ) received topical poultice ( only when necessary ) . Each group received specific weekly treatment five times during the study . Outcome measures were pain intensity in a visual analogue scale ( VAS ) and knee function in terms of the Western Ontario and McMaster Universities Osteoarthritis Index ( WOMAC ) . Results The ACP , TENS and A&T groups reported lower VAS and WOMAC scores than the control group . Significant reduction in pain intensity ( P = 0.039 ) and significant improvement in knee function ( P = 0.008 ) were shown in the A&T group . Conclusion Combined acupuncture and TENS treatment was effective in pain relief and knee function improvement for the sample d patients suffering from knee OA Context Previous studies of acupuncture for osteoarthritis have had conflicting results . This may have occurred because most studies have included small sample s , a limited number of treatment sessions , or other limitations . Contribution This r and omized , controlled trial compared 24 acupuncture sessions over 26 weeks with sham acupuncture or arthritis education in 570 patients with osteoarthritis of the knee .  Acupuncture led to greater improvements in function but not pain after 8 weeks and in both pain and function after 26 weeks . No adverse effects were associated with acupuncture . Caution s Many participants dropped out of the study , so readers should interpret the findings at 26 weeks with caution . The Editors Osteoarthritis is the most common form of arthritis and is a major cause of morbidity , limitation of activity , and health care utilization , especially in elderly patients ( 1 , 2 ) . Pain and functional limitation are the primary clinical manifestations of osteoarthritis of the knee . Current recommendations for managing osteoarthritis , including guidelines published by the American College of Rheumatology ( 3 ) and European League of Associations of Rheumatology ( 4 ) , focus on relieving pain and stiffness and maintaining or improving physical function as important goals of therapy . No curative therapies exist for osteoarthritis ; thus , both pharmacologic and nonpharmacologic management focus on controlling pain and reducing functional limitation ( 5 ) . Nonpharmacologic therapy , which includes patient education , social support , physical and occupational therapy , aerobic and resistive exercises , and weight loss , is the cornerstone of a multidisciplinary approach to osteoarthritis patient management ( 3 ) . Pharmacologic therapies include nonopioid analgesics ( such as acetaminophen ) , nonsteroidal anti-inflammatory drugs ( NSAIDs ) ( including cyclooxygenase-2 [ COX-2 ] enzyme selective inhibitors ) , topical analgesics ( capsaicin cream ) , opioid analgesics , and intra-articular steroid and hyaluronate injections . Often , these agents are used in combination for additive analgesic efficacy ( 6 ) . Pharmacologic management of osteoarthritis is often ineffective , and agents such as NSAIDs may cause unwanted and dangerous side effects ( 7 , 8) . Complementary and alternative medicine is another approach to treating osteoarthritis ( 9 - 12 ) , particularly in Asian societies ( 13 ) . Many U.S. patients with osteoarthritis also use complementary and alternative medical therapies ( 14 ) . A systematic review of acupuncture and knee osteoarthritis ( 15 ) identified 7 small r and omized , controlled trials published in English . Within the method ologic limitations of the studies , the evidence suggested that acupuncture seemed to alleviate knee pain and function compared with sham acupuncture controls , although 2 trials comparing acupuncture with an active , nonpharmacologic treatment ( physical therapy ) did not indicate such an effect ( 16 , 17 ) . Before conducting our large-scale trial , we completed both a pilot study ( 18 ) and a r and omized , single-blind trial ( 19 ) of the effect of acupuncture on osteoarthritis of the knee . Participants in the uncontrolled pilot study ( n= 12 ) showed statistically significant improvement in both self-reported pain and physical function , as well as performance measures of physical function after 8 weeks of acupuncture treatment and at 12-week follow-up as compared with their baseline ( 18 ) . In our larger r and omized , single-blind trial ( n= 73 ) , which examined the benefit of acupuncture added to st and ard management with NSAIDs , the acupuncture  treatment group experienced statistically significant improvements in self-reported pain and disability scores compared with a st and ard-care control group as late as 4 weeks after the end of treatment ( 19 ) . However , this effect diminished within 18 weeks ( 26 weeks after the beginning of the trial ) after the final acupuncture treatment . Together , however , the previously conducted trials ( both our preliminary studies [ 18 , 19 ] and those referenced in the systematic review [ 15 ] ) have 3 method ologic limitations : lack of credible controls for the placebo effect , inadequate assessment of long-term treatment benefits , and insufficient sample sizes . We tested the hypothesis that an 8-week intensive acupuncture treatment regimen , followed by an 18-week tapering regimen , reduces pain and improves function among patients with knee osteoarthritis as compared with both sham acupuncture and education control groups . Methods Patient Recruitment We recruited patients for this multisite , placebo-controlled trial from March 2000 through December 2003 , primarily through print and radio advertisements . The 3 sites were the Integrative Medicine Clinic of the University of Maryl and School of Medicine , Baltimore , Maryl and ; the Innovative Medical Research Center ( a private research firm ) , Towson , Maryl and ; and the Hospital for Special Surgery , New York City , New York . The institutional review boards of the 3 sites approved the study . We determined the sample size ( n= 570 ) by a power analysis based on our r and omized pilot study ( 19 ) , adjusted by the estimated decrease in effect size result ing from the inclusion of a sham acupuncture group design ed to control for placebo effects . Patients met the following inclusion criteria : age 50 years or older , a diagnosis of osteoarthritis of the knee , radiographic evidence of at least 1 osteophyte at the tibiofemoral joint ( KellgrenLawrence grade 2 ) , moderate or greater clinical ly significant knee pain on most days during the past month , and willingness to be r and omly assigned . Exclusion criteria were the presence of serious medical conditions that precluded participation in study , bleeding disorders that might contraindicate acupuncture , intra-articular corticosteroid or hyaluronate injections ( as well as any knee surgeries or concomitant use of topical capsaicin cream ) during the past 6 months , previous experience with acupuncture , or any planned events ( including total knee replacement ) that would interfere with participation in the study during the following 26 weeks . After a brief telephone screening , patients were scheduled to visit 1 of the 3 participating sites to sign an informed consent statement and undergo a brief rheumatologic examination ( including radiographic examination of affected knees ) by a physician or a nurse practitioner . Because the education course was a group activity , patients were recruited until a cohort of 12 to 21 patients was formed , at which point each cohort at each site was r and omly assigned to 1 of 3 groups by a computer-generated process using r and omly selected blocks of 3 , 6 , and 9 . We assured allocation concealment by using disguised letter codes that were generated and sent to the site coordinators by a central statistical core . We used this procedure to ensure that approximately equal numbers of participants were in each treatment group across the course of the study , to ensure that each cohort would have participants assigned to all 3 treatment groups , and to make the breaking of the group assignment process more difficult . The research assistants who collected assessment s from participants , the participants themselves ( in the true acupuncture and sham acupuncture groups ) , and the statistician were blinded to group assignment . Assessment s were conducted at baseline and 4 , 8 , 14 , and 26 weeks after r and omization . Study Interventions We developed and modified the acupuncture treatment and sham control protocol s from previously reported and vali date d procedures ( 18 - 21 ) . During the trial , 7 acupuncturists were used : 3 at the Integrative Medicine Clinic , 3 at the Innovative Medical Research Center , and 1 at the Hospital for Special Surgery . In general , acupuncturists were assigned to the same participants throughout the 26-week treatment schedule , except for vacation conflicts and staff turnover , and provided approximately the same proportions of true versus sham procedures . All acupuncturists were state-licensed and had at least 2 years of clinical experience . The study 's principal acupuncturist trained and supervised the acupuncturists in performing true or sham procedures and avoiding interactions that could inadvertently communicate group assignment . True Acupuncture The true acupuncture  ( experimental ) group underwent 26 weeks of gradually tapering treatment according to the following schedule : 8 weeks of 2 treatments per week followed by 2 weeks of 1 treatment per week , 4 weeks of 1 treatment every other week , and 12 weeks of 1 treatment per month . We based the acupuncture point selection s on Traditional Chinese Medicine meridian theory to treat knee joint pain , known as the Bi syndrome . These points consisted of 5 local points ( Yanglinquan [ gall bladder meridian point 34 ] , Yinlinquan [ spleen meridian point 9 ] , Zhusanli [ stomach meridian point 36 ] , Dubi [ stomach meridian point 35 ] , and extra point Xiyan ) and 4 distal points ( Kunlun [ urinarybladder , meridian point 60 ] , Xuanzhong [ gall bladder meridian point 39 ] , Sanyinjiao [ spleen meridian point 6 ] , and Taixi [ kidney meridian point 3 ] ) on meridians that traverse the area of pain ( 22 , 23 ) . The same points were treated for each affected leg . If both knees were affected , 9 needles were inserted in each leg . ( The outcome measures were not specifically targeted to whether the patient had osteoarthritis in 1 or both knees , and we observed no differential effects on the basis of the number of knees treated . ) The acupuncturists inserted 1.5-inch ( for local points ) and 1-inch ( for distal points ) 32-gauge ( 0.25-mm diameter ) acupuncture needles to a conventional depth of approximately 0.3 to 1.0 inch , depending on point location . All participants in the treatment group achieved the De-Qi sensation , a local sensation of heaviness , numbness , soreness , or paresthesia that accompanies the insertion and manipulation of needles during acupuncture , at these 9 points . Acupuncturists applied electrical OBJECTIVE To explore the efficacy on knee osteoarthritis ( KOA ) treated with different acupuncture methods at different stages . METHODS One hundred and eighty cases of KOA were divided into stagnation stage , fascia cramp stage and tendon lesion stage according to the condition of disease , 60 cases in each stage . Each stage was r and omized into a staging treatment group and an electroacupuncture ( EA ) group , 30 cases in each one . In the staging treatment group , acupuncture at the tendon points of meridians and electric thermal needling method were adopted for the cases at the stagnation stage ; the small needle-knife therapy and bleeding method were used for the cases at the fascia cramp stage ; and the electric thermal therapy with thick silver needles was applied for the cases at the tendon lesion stage . In the EA group , EA was applied for the cases of all the three stages at Liangqiu ( ST 34 ) , Xuehai ( SP 10 ) , Yanglingquan ( GB 34 ) , etc . RESULTS The total effective rate was 96.1 % ( 87/90 ) in the staging treatment group and was 91.1 % ( 82/90 ) in the EA group , without significant difference in comparison ( P > 0.05 ) . The controlled and remarkably effective rate ( 88.9 % , 80/90 ) in the staging treatment group was higher apparently than ( 62.2 % , 56/90 ) in the EA group ( P < 0.001 ) . And in the EA group , with the disease progression and the further disease stages , the controlled and remarkably effective rate was reduced . After treatment , the scores of symptoms and signs were decreased in both groups ( both P < 0.001 ) , the improvement in the staging treatment group was superior to that in the EA group ( P < 0.001 ) . CONCLUSION The different acupuncture methods at the three stages improve obviously the clinical effect and are highly targeted . The mechanism of the three stages on " meridian muscle region pathology " and the treatment based on the disease stages can be the effective approach to KOA Acupuncture is one of the most widely used and broadly research ed of the complementary and alternative therapies , but high- quality trials generally show no benefit over sham acupuncture . Many would view this result as evidence of ineffectiveness for this intervention . This discussion article focuses on the report of a large multicenter r and omized controlled trial of  acupuncture for chronic low-back pain ( CLBP ) in the lay and academic press , the ensuing discussion , and its impact on both clinical practice and service provision . The authors suggest that interpretive bias has affected reporting , leading to question able conclusions and advocacy in favor of this form of care that may exceed the evidence . They also suggest that a lack of underst and ing of research into the placebo effect may have contributed to confusion in the interpretation of these trials Background : To evaluate the safety of acupuncture in a large number of patients receiving conventional health care and , based on these results , to develop a new medical consent form for acupuncture . Methods : The prospect i ve observational study included patients who received acupuncture treatment for chronic osteoarthritis pain of the knee or hip , low back pain , neck pain or headache , allergic rhinitis , asthma , or dysmenorrhoea . After treatment , all patients documented adverse events associated with acupuncture ( defined as adverse effects ) . Patients who reported a need for treatment due to an adverse effect completed an additional st and ardised question naire on the most important adverse effect . Based on this data and considering ethical and legal aspects a new consent form was developed . Results : A total of 229,230 patients received on average 10.2 ± 3.0 acupuncture treatments . Altogether , 19,726 patients ( 8.6 % ) reported experiencing at least one adverse effect and 4,963 ( 2.2 % ) reported one which required treatment . Common adverse effects were bleedings or haematoma ( 6.1 % of patients , 58 % of all adverse effects ) , pain ( 1.7 % ) and vegetative symptoms ( 0.7 % ) . Two patients experienced a pneumothorax ( one needed hospital treatment , the other observation only ) . The longest duration of a side effect was 180 days ( nerve lesion of the lower limb ) . The result ing medical consent form consists of five modules : Introduction to acupuncture and moxibustion , Risks of acupuncture treatment , Conditions which can increase the risk , Doctor ’s statement , and Consent . Conclusion : Acupuncture provided by physicians is a relatively safe treatment and the proposed consent form could support both patients and professionals in the process of obtaining informed consent OBJECTIVE To evaluate the clinical efficacy and efficacy sustainable time of acupuncture in knee osteoarthritis ( KOA ) . METHODS The non-r and omized concurrent control trial was adopted . One hundred and ninety-three cases of KOA were divided into an immediate acupuncture group ( group A , 97 cases ) and a delayed acupunc-weeks at the end of treatment . In group B , the same acupuncture therapy was applied after waiting 4 weeks . The acupoints in the two groups were Liangqiu ( ST 34 ) , Dubi ( ST 35 ) , Zusanli ( ST 36 ) , Yanglingquan ( GB 34 ) , Yinlingquan ( SP 9 ) , Xuehai ( SP 10 ) , Xiyan ( EX-LE 4 ) , Xiyangguan ( GB 33 ) . WOMAC ( Western Ontario and McMasters Universities Osteoarthritis ) was used for the assessment of the primary index and VAS ( visual analogue scale ) was for the secondary index . The evaluation was accomplished by the patients at the beginning of trial , on the 4th and 8th weeks . In each group , 72 patients finished the trial and the data of the lost cases were included in the final data analysis . RESULTS In the 4th week of trial , WOMAC score was ( 25 . 8+/-22.0 ) in group A difference ( P<0 . 001 ) . VAS scorewas ( 31 . 8+/-24 . and was ( 43.8+/-22.2 ) in group B , indicating the significant 6 ) in group A and was ( 56 . 6 + /-25 . 8) in group B , indicating very significant difference ( P<0 . 001 ) . In the 8th week , the efficacy was reduced slightly in the follow-up of group A , but it was improved apparently as compared Acupuncture relieves joint pain and improves joint function obviously.by th patiĩeffr , a Mtaetfti-?an tf ri-with that before treatment . CONCLUSION Acupuncture relieves joint pain and improves joint function obviously . The effect of acupuncture is still sustainable in 4 weeks after terminating the treatment IMPORTANCE There is debate about benefits of acupuncture for  knee pain . OBJECTIVE To determine the efficacy of laser and needle acupuncture for  chronic knee pain . DESIGN , SETTING , AND PARTICIPANTS Zelen- design clinical trial ( r and omization occurred before informed consent ) , in Victoria , Australia ( February 2010-December 2012 ) . Community volunteers ( 282 patients aged ≥50 years with chronic knee pain ) were treated by family physician acupuncturists . INTERVENTIONS No acupuncture ( control group , n = 71 ) and needle ( n = 70 ) , laser ( n = 71 ) , and sham laser ( n = 70 ) acupuncture . Treatments were delivered for 12 weeks . Participants and acupuncturists were blinded to laser and sham laser acupuncture . Control participants were unaware of the trial . MAIN OUTCOMES AND MEASURES Primary outcomes were average knee pain ( numeric rating scale , 0 [ no pain ] to 10 [ worst pain possible ] ; minimal clinical ly important difference [ MCID ] , 1.8 units ) and physical function ( Western Ontario and McMaster Universities Osteoarthritis Index , 0 [ no difficulty ] to 68 [ extreme difficulty ] ; MCID , 6 units ) at 12 weeks . Secondary outcomes included other pain and function measures , quality of life , global change , and 1-year follow-up . Analyses were by intention-to-treat using multiple imputation for missing outcome data . RESULTS At 12 weeks and 1 year , 26 ( 9 % ) and 50 ( 18 % ) participants were lost to follow-up , respectively . Analyses showed neither needle nor laser acupuncture  significantly improved pain ( mean difference ; -0.4 units ; 95 % CI , -1.2 to 0.4 , and -0.1 ; 95 % CI , -0.9 to 0.7 , respectively ) or function ( -1.7 ; 95 % CI , -6.1 to 2.6 , and 0.5 ; 95 % CI , -3.4 to 4.4 , respectively ) compared with sham at 12 weeks . Compared with control , needle and laser acupuncture result ed in modest improvements in pain ( -1.1 ; 95 % CI , -1.8 to -0.4 , and -0.8 ; 95 % CI , -1.5 to -0.1 , respectively ) at 12 weeks , but not at 1 year . Needle acupuncture result ed in modest improvement in function compared with control at 12 weeks ( -3.9 ; 95 % CI , -7.7 to -0.2 ) but was not significantly different from sham ( -1.7 ; 95 % CI , -6.1 to 2.6 ) and was not maintained at 1 year . There were no differences for most secondary outcomes and no serious adverse events . CONCLUSIONS AND RELEVANCE In patients older than 50 years with moderate or severe chronic knee pain , neither laser nor needle acupuncture conferred benefit over sham for pain or function . Our findings do not support acupuncture for these patients . TRIAL REGISTRATION anzctr.org.au Identifier : ACTRN12609001001280 Abstract Objective To investigate whether a sham device ( a vali date d sham acupuncture needle ) has a greater placebo effect than an inert pill in patients with persistent arm pain . Design A single blind r and omised controlled trial created from the two week placebo run-in periods for two nested trials that compared acupuncture and amitriptyline with their respective placebo controls . Comparison of participants who remained on placebo continued beyond the run-in period to the end of the study . Setting Academic medical centre . Participants 270 adults with arm pain due to repetitive use that had lasted at least three months despite treatment and who scored ≥3 on a 10 point pain scale . Interventions Acupuncture with sham device twice a week for six weeks or placebo pill once a day for eight weeks . Main outcome measures Arm pain measured on a 10 point pain scale . Secondary outcomes were symptoms measured by the Levine symptom severity scale , function measured by Pransky 's upper extremity function scale , and grip strength . Results Pain decreased during the two week placebo run-in period in both the sham device and placebo pill groups , but changes were not different between the groups ( −0.14 , 95 % confidence interval −0.52 to 0.25 , P = 0.49 ) . Changes in severity scores for arm symptoms and grip strength were similar between groups , but arm function improved more in the placebo pill group ( 2.0 , 0.06 to 3.92 , P = 0.04 ) . Longitudinal regression analyses that followed participants throughout the treatment period showed significantly greater downward slopes per week on the 10 point arm pain scale in the sham device group than in the placebo pill group ( −0.33 ( −0.40 to −0.26 ) v −0.15 ( −0.21 to −0.09 ) , P = 0.0001 ) and on the symptom severity scale ( −0.07 ( −0.09 to −0.05 ) v −0.05 ( −0.06 to −0.03 ) , P = 0.02 ) . Differences were not significant , however , on the function scale or for grip strength . Reported adverse effects were different in the two groups . Conclusions The sham device had greater effects than the placebo pill on self reported pain and severity of symptoms over the entire course of treatment but not during the two week placebo run in . Placebo effects seem to be malleable and depend on the behaviours embedded in medical rituals OBJECTIVE To objective ly evaluate the clinical efficacy of stiletto needle for pain of knee osteoarthri tis ( KOA ) , and analyze its function mechanism . METHODS Seventy-six cases of KOA ( 76 knees ) were selected . Under the guide of Jingjin theory in TCM , stiletto needle was applied at pain point of Jingjin in extra-articular area to have a loose solution effect , 1 to 3 points were selected each time , 1 to 2 times of treatment were required . The results of tenderness measurement instrument was adopted as main evaluation index of joint pain , and all data of evaluation indices before and after the treatment were statistical analyzed . RESULTS There were significant differences in visual analogue scale ( VAS ) score , tenderness score , HSS function score and movement range of joint before and after the treatment ( all P < 0.05 ) . The effective rate  of stiletto needle therapy  was 89.5 % . There was apparent regression trend between VAS score and tenderness score with Y ( VAS ) = 7.841 - 1.569 X ( tenderness score ) as its regressive equation . CONCLUSION The stiletto needle therapy is an effective method to relieve the pain of knee osteoarthritis , and its clinical efficacy evaluation could be more objective and digital with tenderness measurement instrument OBJECTIVE To compare the efficacy difference in the treatment of knee osteoarthritis between acupuncture at Neiguan ( PC 6 ) and Taichong ( LR 3 ) and the conventional acupoints . METHODS Forty four cases were r and om into a  Neiguanc ( PC 6 ) Taichong ( LR 3 ) group observation group ( 20 cases ) and a conventional group control group ( 24 cases ) . In the observention group , acupuncture was applied to Neiguan ( PC 6 ) on the healthy side and Taichong ( LR 3 ) on the affected side . The acupoints were selected bilaterally if both knees were affected . In the control group , acupuncture was applied to Yanglingquan ( GB 34 ) , Yinlingquan ( SP 9 ) , Neixiyan ( EX-LE 4 ) , Dubi ( ST 35 ) , Zusanli ( ST 36 ) and the others on the affected side . The visual analogue scale ( VAS ) and Western Ontario and McMaster University Osteoarthritis Index ( WOMAC ) were used for assessment of theraputic effect after treatment . RESULTS The score of VAS and pain , stiffness and function impairment of WOMAC were lower apparently than those before treatment in both groups ( all P < 0.001 ) . VAS score after treatment in the observation group was lower apparently than that in the control group ( P < 0.05 ) . The differences in each item score of WOMAC after treatment were not significant statistically between the two groups ( all P > 0.05 ) . CONCLUSION Acupuncture at Neiguan ( PC 6 ) and Taichong ( LR 3 ) achieves the similar efficacy on knee osteoarthritis as the conventional acupoints , but the former is more simple and convenient Background Controlled clinical trials produced contradictory results with respect to a specific analgesic effect of acupuncture . There is a lack of large multi-centre acupuncture trials . The German Acupuncture Trial represents the largest multi-centre study of acupuncture in the treatment of  chronic pain caused by gonarthrosis up to now . Methods 900 patients will be r and omised to three treatment arms . One group receives verum acupuncture , the second sham acupuncture , and the third conservative st and ard therapy . The trial protocol is described with eligibility criteria , detailed information on the treatment definition , blinding , endpoints , safety evaluation , statistical methods , sample size determination , monitoring , legal aspects , and the current status of the trial . Discussion A critical discussion is given regarding the considerations about st and ardisation of the acupuncture treatment , the choice of the control group , and the blinding of patients and observers Objective : The primary aim was to establish from  acupuncture patients the type and frequency of adverse events they experienced and attributed to their treatment . Secondary aims included the measurement of patient reported adverse consequences arising from advice received about conventional/prescribed medication or from delayed conventional diagnosis and treatment . Methods : Postal survey of prospect ively identified acupuncture patients . One in three members of the British Acupuncture Council ( n = 638 ) invited consecutive patients to participate in the survey . Participating patients gave baseline data and consented to direct follow up by the research ers at 3 months . A structured question naire was used to collect data on perceived adverse events . Results : 9408 patients gave baseline information and consent and 6348 ( 67 % ) completed 3 month question naires . Responders were not dissimilar to non-responders for all known characteristics . 682 patients reported at least one adverse event over 3 months , a rate of 107 per 1000 patients ( 95 % CI 100 to 115 ) . Three patients reported a serious adverse event . The most common events reported were severe tiredness and exhaustion , pain at the site of needling , and headache .  Patients receiving acupuncture treatment  that was not funded by the NHS and patients not in contact with a GP or hospital specialist were less likely to report adverse events ( odds ratios 0.59 and 0.66 , respectively ) . 199 ( 3 % ) of responding patients reported receiving advice about conventional/prescribed medication , six of whom reported adverse consequences after taking the advice . Two patients reported  delayed conventional treatment .  Conclusion : Patients report a range of adverse events but these do not prevent most patients seeking further acupuncture . This large scale survey supports existing evidence that acupuncture is a relatively safe intervention when practised by regulated practitioners Acupuncture is becoming a common technique within the physiotherapy profession as a treatment modality for pain relief ; however , few r and omised controlled trials have been undertaken to assess the effectiveness of acupuncture , particularly in the treatment of osteoarthritis ( OA ) of the hip . Therefore , a r and omised trial to compare the effectiveness of acupuncture with advice and exercises on the symptomatic treatment of OA of the hip was carried out . Thirty-two patients awaiting a total hip arthroplasty were r and omly allocated to either the experimental group , ( A ) , to have six sessions of acupuncture each lasting up to 25 minutes , or the control group , ( B ) , to be given advice and exercises for their hip over a six week period . Group A consisted of three men and 13 women , and group B consisted of four men and eight women . The average age in group A was 66 years and in group B it was 68 years . Patients were assessed for pain and functional ability , using a modified version of the WOMAC question naire , pre-treatment , immediately post-treatment and at eight weeks post-treatment . The pre-treatment WOMAC scores in the two groups were similar ( p=0.85 ) . There was a significant improvement in group A ( decrease in WOMAC score ) immediately post-treatment ( p=0.002 ) and this was maintained at the eight-week follow-up ( p=0.03 ) . There were no significant changes in group B. When the changes in WOMAC scores were compared between groups , a significantly greater improvement was found between pre-treatment and immediately post-treatment in group A , compared with group B ( p=0.02 ) . The changes between pre-treatment and the eight-week follow-up also showed a significant improvement in group A compared with group B ( p=0.03 ) . In conclusion , this trial supports the hypothesis that acupuncture is more effective than advice and exercises in the symptomatic treatment of OA of the hip Background The purpose of this study was to compare the efficacy of electroacupuncture ( EA ) , diclofenac and their combination in symptomatic treatment of osteoarthritis ( OA ) of the knee . Methods This study was a r and omized , single-blind , placebo controlled trial . The 193 out- patients with OA of the knee were r and omized into four groups : placebo , diclofenac , EA and combined ( diclofenac plus EA ) . Paracetamol tablets were prescribed as a rescue analgesic during the study . The patients were evaluated after a run-in period of one week ( week 0 ) and again at the end of the study ( week 4 ) . The clinical assessment s included the amount of paracetamol taken/week , visual analog scale ( VAS ) , Western Ontario and McMaster Universities ( WOMAC ) OA Index , Lequesne 's functional index , 50 feet-walk time , and the orthopedist 's and patient 's opinion of change . Results One hundred and eighty six patients completed the study . The improvement of symptoms ( reduction in mean changes ) in most outcome parameters was greatest in the EA group . The proportions of responders and patients with an overall opinion of " much better " were also greatest in the EA group . The improvement in VAS was significantly different between the EA and placebo group as well as the EA and diclofenac group . The improvement in Lequesne 's functional index also differed significantly between the EA and placebo group . In addition , there was a significant improvement in WOMAC pain index between the combined and placebo group . Conclusion EA is significantly more effective than placebo and diclofenac in the symptomatic treatment of OA of the knee in some circumstances . However , the combination of EA and diclofenac treatment was no more effective than EA treatment alone OBJECTIVE To observe the differences of effect of electroacupuncture and medication on hip osteoarthritis . METHODS Sixty cases were r and omly divided into an electroacupuncture group and a medication group , 30 cases in each one . In electroacupuncture group , electroacupuncture was applied at Biguan ( ST 31 ) , Juliao ( GB 29 ) , Zuwuli ( LR 10 ) and Yinlian ( LR 11 ) . In medication group , Diclofenac Sodium was prescribed for oral administration . One month after treatment , Visual Analogue Scale ( VAS ) and Harris score were compared between two groups . RESULTS VAS scores were 67.83 + /- 8.48 and 55.83 + /- 9.66 before and after treatment in electroacupuncture group , and were 68.67 + /- 8.09 and 61.50 + /- 7.78 in medication group separately . VAS pain scores after treatment were reduced remarkably in two groups ( both P < 0.001 ) , but the score was reduced much more remarkably in electroacupuncture group as compared with medication group . In electroacupuncture group , after treatment , Harris total score , the single scores of joint pain , function and motion range increased apparently as compared with those before treatment ( all P < 0.001 ) . In medication group , after treatment , Harris total score and pain score increased remarkably as compared with those before treatment ( both P < 0.001 ) . Harris total score , pain score and function score after treatment in electroacupuncture group increased much more remarkably as compared with those in medication group ( all P < 0.05 ) . CONCLUSION Electroacupuncture can treat effectively hip osteoarthritis , relieve joint pain and improve joint function . The efficacy of it is superior to that of oral administration of Diclofenac Sodium BACKGROUND There is lack of well- design ed trials evaluating structural benefits of non-pharmacologic therapies in knee osteoarthritis ( OA ) . In this parallel-group r and omized controlled trial , we aim to compare the possible advantages of lateral wedge insole and acupuncture in patients with medial knee OA . METHOD Patients with grade two or three of medial knee OA were r and omly allocated to group one who received an in shoe lateral wedge and group two who underwent acupuncture . We assessed patients ' pain , function and knee joint cartilage thickness before and after intervention . Paired t-test and independent sample s t-test were used for in group and between group analyses . ( LEVEL OF EVIDENCE 2 . ) RESULTS Twenty patients in each group were recruited in the study .  Pain significantly decreased after therapy in both groups one and two ( paired t test , P<0.001 , 95 % CI : 1.62 - 3.25 and 1.58 - 3.20 respectively ) . Function improved in each group ( paired t test , P=0.001 , 95 % CI of 0.94 - 2.38 in group one and 0.97 - 2.43 in group two ) . A non- clinical ly statistically significant difference regarding the femoral and tibial cartilage thickness was obtained in both groups one ( P=0.005 , CI : -0.43 - 0.82 and P=0.037 , CI : -0.44 - 0.80 respectively ) and two ( P=0.025 , CI : -0.45 - 0.79 and P=0.035 , CI : -0.29 - 0.96 respectively ) . Between groups analysis showed no significant difference regarding abovementioned measures . CONCLUSION Both lateral wedge insole and acupuncture can be effective in the treatment of medial knee osteoarthritis without any superiority of one over the other . Iranian Registry of Clinical Trials : I RCT 201201108235N1 . URL : http://i rct .ir/ search en.php Forty-four patients with chronic cervical osteoarthritis took part in this study . Patients were treated with acupuncture , sham-acupuncture , diazepam or placebo-diazepam in r and omized order . Pain was rated on visual analogue scales before , during , and after treatment . Two scales were separately used to rate the intensity ( sensory component ) and the unpleasantness ( affective component ) of pain . The results analyzed from these trials show that diazepam , placebo-diazepam , acupuncture and sham-acupuncture have a more pronounced effect on the affective than on the sensory component of pain .  Acupuncture was significantly more effective than placebo-diazepam ( p less than 0.05 ) , but not significantly more effective than diazepam or sham-acupuncture OBJECTIVE The purpose of this study was to determine whether acupuncture was more effective than sham acupuncture in the reduction of pain in persons with osteoarthritis ( OA ) of the knee . METHODS Forty subjects ( 20 men , 20 women ) with radiographic evidence of OA of the knee were stratified by gender and r and omly assigned to either the experimental ( real acupuncture ) or control ( sham acupuncture ) groups . Subjects were treated three times per week for 3 weeks and evaluated at three test sessions . Outcome measures were : 1 ) the Pain Rating Index of the McGill Pain Question naire , 2 ) the Western Ontario and McMaster Universities ( WOMAC ) Osteoarthritis Index , and 3 ) pain threshold at four sites at the knee . RESULTS The analyses of variance showed that both real and sham acupuncture significantly reduced pain , stiffness , and physical disability in the OA knee , but that there were no significant differences between groups . CONCLUSIONS Acupuncture is not more effective than sham acupuncture in the treatment of OA pain Objective To investigate whether placebo effects can experimentally be separated into the response to three components— assessment and observation , a therapeutic ritual ( placebo treatment ) , and a supportive patient-practitioner relationship— and then progressively combined to produce incremental clinical improvement in patients with irritable bowel syndrome . To assess the relative magnitude of these components . Design A six week single blind three arm r and omised controlled trial . Setting Academic medical centre . Participants 262 adults ( 76 % women ) , mean ( SD ) age 39 ( 14 ) , diagnosed by Rome II criteria for and with a score of ≥150 on the symptom severity scale . Interventions For three weeks either waiting list ( observation ) , placebo acupuncture alone ( “ limited ” ) , or placebo acupuncture with a patient-practitioner relationship augmented by warmth , attention , and confidence ( “ augmented ” ) . At three weeks , half of the patients were r and omly assigned to continue in their originally assigned group for an additional three weeks . Main outcome measures Global improvement scale ( range 1 - 7 ) , adequate relief of symptoms , symptom severity score , and quality of life . Results At three weeks , scores on the global improvement scale were 3.8 ( SD 1.0 ) v 4.3 ( SD 1.4 ) v 5.0 ( SD 1.3 ) for waiting list versus “ limited ” versus “ augmented , ” respectively ( P<0.001 for trend ) . The proportion of patients reporting adequate relief showed a similar pattern : 28 % on waiting list , 44 % in limited group , and 62 % in augmented group ( P<0.001 for trend ) . The same trend in response existed in symptom severity score ( 30 ( 63 ) v 42 ( 67 ) v 82 ( 89 ) , P<0.001 ) and quality of life ( 3.6 ( 8.1 ) v 4.1 ( 9.4 ) v 9.3 ( 14.0 ) , P<0.001 ) . All pairwise comparisons between augmented and limited patient-practitioner relationship were significant : global improvement scale ( P<0.001 ) , adequate relief of symptoms ( P<0.001 ) , symptom severity score ( P=0.007 ) , quality of life ( P=0.01 ) . Results were similar at six week follow-up . Conclusion Factors contributing to the placebo effect can be progressively combined in a manner resembling a grade d dose escalation of component parts . Non-specific effects can produce statistically and clinical ly significant outcomes and the patient-practitioner relationship is the most robust component . Trial registration Clinical Trials NCT00065403 OBJECTIVE To observe the therapeutic effect of different schemes of mild moxibustion for treatment of ( yang-deficiency induced cold-accumulation type)knee osteoarthritis ( KOA ) . METHODS Fifty-nine KOA patients were chosen and r and omly divided into control group ( n = 30 ) and test group ( n = 29 ) . Patients of the control group were treated by mild moxi- bustion of Neixiyan ( EX-HE4 ) and Waixiyan ( ST 35 ) for 30 min , once daily for 14 days ( two courses ) , and those of the test group were treated by mild moxibustion of EX-HE 4 and ST 35 for 30 mini once daily for 7 days ( the same to control group ) , followed by moxibustion of Yaoyangguan ( GV 3 ) and Mingmen ( GV 4 ) once daily for next 7 days more . In addition , patients of the two groups were also treated by routine acupuncture stimulation of EX-HE 4 , ST 35 , Yanglingquan ( GB 34 ) , Kunlun ( BL 60 ) , etc . The interval between two therapeutic courses was one day . The Lysholm Knee Score Scale ( LKSS ) was used to evaluate the therapeutic effect . Visual analogue scale ( VAS ) was employed to assess the patient 's knee-joint pain severity ( arthralgia ) , and scores of morning stiffness , arthrocele , and walking restraint degree of the knee-joint were also evaluated before and after the treatment . RESULTS After the treatment , the scores of VAS , morning stiffness , arthrocele and walking restraint degree of the knee-joint of both groups were significantly decreased ( P<0 . 05 ) , and the scores of the test group were obviously lower than those of the con- trol group ( P<0 . 05 ) . The effective rate of the test group was 89.66 % (26/29)which was obviously higher than that ( 70.00 % , 21/30 ) of the control group ( P<0 . 05 ) . CONCLUSION Mild moxibustion of Neixiyan ( EX-HE 4 ) and Waixiyan ( ST 35 , local acu- points ) , and Yaoyangguan ( GV 3 ) and Mingmen ( GV 4 ) has a better therapeutic effect for KOA patients than moxibustion of local acupoints only OBJECTIVE To observe therapeutic efficacy  of osteoarthritis treated by electroacupuncture , and explore its function of promoting cartilage restoration . METHODS According to r and om digital table , sixty cases of knee osteoarthritis ( 60 knees ) were r and omly divided into an electroacupuncture group and a physiotherapy group , 15 cases ( 30 knees ) in each one . The electroacupuncture was applied at Neixiyan ( EX-LE 4 ) , Dubi ( ST 35 ) , Heding ( EX-LE 2 ) and Xuehai ( SP 10 ) in the electroacupuncture group , once every other day . The physiotherapy group was treated by medium-frequency therapeutic apparatus every day . For both groups , 4 weeks of treatment were required . The Lysholm knee scoring scale ( LKSS ) was used to evaluate and compare the knee joints function before and after treatment . At the same time , the GE Signa EXCITE Twin Speed HD 1.5 T was used to take MRI examination of knee joints , and measure the T2 values in 10 sub-regions of the cartilage of tibiofemoral joints . RESULTS Compared before treatment , the LKSS score of both groups were improved with significant differences except item dem and s for support ( P < 0.01 , P < 0.05 ) . Between the two groups after treatment , there were significant differences on total score , item instability and swelling ( all P < 0.05 ) , the electroacupuncture group was better than the physiotherapy group , but no significant difference on the other items ( all P > 0.05 ) . In the electroacupuncture group after treatment , T2 value in anterior lateral tibial sub-region ( LTa ) was significantly lowered ( P < 0.05 ) , but no significant difference in the other nine sub-regions ( all P > 0.05 ) . In the physiotherapy group , T2 value in any sub-region was not significantly different before and after treatment ( all P > 0.05 ) . CONCLUSION Electroacupuncture could effectively improve the symptom , sign and knee joint 's function of patients with knee osteoarthritis . Compared with physiotherapy , it has more superior effect and considered as a better non-operative treatment for osteoarthritis . Electroacupuncture also has positive influence on T2 value in cartilage , indicating that electroacupuncture may have the function of promoting cartilage restoration OBJECTIVE To observe the long-term efficacy and safety of warm needling therapy combined with rehabilitation training in the treatment of knee osteoarthritis ( KOA ) for the patients living in simple room after earthquake . METHODS Eighty-eight cases of KOA were r and omized into a warm needling group and an acupuncture group , 44 cases in each one . In the warm needling group , the warm needling therapy was applied at Neixiyan ( EX LE 4 ) and Dubi ( ST 35 ) , in combination with rehabilitation training . In the acupuncture group , the same rehabilitation training was received , and the same acupoints were selected as the warm needling group , but only stimulated with acupuncture without moxibustion applied . The clinical efficacy was observed after 20 treatments and in 1 - 2 months of follow-up . RESULTS The total effective rate was 100.0 % ( 41/41 ) in the warm needling group , which was apparently superior to 85.4 % ( 35/41 ) in the acupuncture group ( P < 0.05 ) . The symptom integral , pain and knee joint function score were all improved significantly after 20 treatments in both groups ( all P < 0.05 ) . The improvements in symptoms and pain in the warm needling group were superior apparently to the acupuncture group ( all P < 0.05 ) . The efficacy remained well within 2 months follow-up ( all P < 0.05 ) . But the difference in knee joint function score was not statistically significant between the two groups ( all P > 0.05 ) . CONCLUSION The combined therapy of warm needling and rehabilitation training achieves the superior efficacy and good safety in the treatment of KOA as compared with the combined therapy of simple acupuncture and rehabilitation training for the patients living in simple room after earthquake Background : We report on the study design and protocol s of two r and omized controlled trials ( Acupuncture R and omized Trials = ART ) that investigate the efficacy of acupuncture in the treatment of chronic low back pain and osteoarthritis of the knee , respectively . Objective : To investigate whether acupuncture is more efficacious than ( a ) no treatment or ( b ) minimal acupuncture in the treatment of low back pain and osteoarthritis . Design : Two r and omized , controlled , multicenter trials with three treatment arms and a total follow-up time of 52 weeks . Setting : 30 practitioners and outpatient units in Germany specialized in acupuncture treatment . Patients : 300 patients will be included in each study . In the low back pain trial , patients will be included according to clinical diagnosis . In the osteoarthritis pain trial , patients will be included according to the American College of Rheumatology criteria . Interventions : Patients are r and omly assigned to receive either ( 1 ) semi-st and ardized acupuncture ( 150 patients ) , ( 2 ) minimal acupuncture at non-acupuncture points ( 75 patients ) , or ( 3 ) no treatment for two months followed by semi-st and ardized acupuncture ( 75 patients , waiting list control ) . Acupuncture treatment consists of 12 sessions per patient over a period of 8 weeks . Main Outcome Measure : The main outcome measure is the difference between baseline and the end of the 8-week treatment period in the following parameters : pain intensity as measured by a visual analogue scale ( VAS ; 0–100 mm ) in the low back pain trial and by the Western Ontario and McMaster Universities Osteoarthritis Score ( WOMAC ) in the osteoarthritis trial . Outlook : The results of these two studies ( available in 2004 ) will provide health care providers and policy makers with the information needed to make scientifically sound assessment s of acupuncture therapy Background In China , heat-sensitive moxibustion ( HSM ) is used for knee osteoarthritis ( KOA ) to reduce pain and improve physical activity . However , there is little high- quality evidence of its effectiveness . Objective To evaluate the effectiveness of HSM in the treatment of KOA compared with usual care . Methods We performed a multicentre , r and omised controlled trial . In total , 432 patients with KOA were r and omly assigned to one of three groups ( HSM , conventional moxibustion , or conventional injection with sodium hyaluronate ) . The primary end point was the guiding principle of clinical research on new drugs in the treatment of KOA ( GPCRND-KOA ) . Measurements were obtained at baseline and after 1 and 6 months ( month 7 ) of study . Result For GPCRND-KOA , there were significant differences among the three groups after treatment at months 1 and 7 . Pairwise comparisons showed that HSM was more effective than the conventional drug . There was no difference in any measures between conventional moxibustion and the conventional drug . Compared with conventional moxibustion , HSM result ed in greater improvement in all outcomes . Conclusions This trial provided some evidence of the superiority of  HSM  in patients with KOA , suggesting that the observed differences might be due to superiority effects of a heat-sensitive point , although the effect of expectation can not be ruled out . Trial Registration Number The trial was registered at Controlled Clinical Trials : ChiCTR-TRC-09000600 Purpose : Acupuncture treatment of patients waiting for arthroplasty surgery . Methods : 29 patients with a total of 42 osteoarthritic knees were r and omized to two groups . Group A was treated while Group B served as a no‐treatment control group . After 9 weeks Group B was treated too . Analgesic consumption , pain and objective measurements were registered . All objective measures were done by investigators who were “ blinded ” as to Group A & B. In the second part of the study 17 patients ( 26 knees ) continued with treatments once a month . Registration of analgesic consumption , pain and objective measurements continued . Total study period 49 weeks . Results : Comparing Group A to B there was a significant reduction in pain , analgesic consumption and in most objective measures . In Group A + B combined there was an 80 % subjective improvement , and a significantly increased knee range movement – an increase mainly in the worst knees . Results were significantly better in those who had not been ill for a long time . In the second part of the study , it was shown that it was possible to maintain the improvements . Conclusions : Acupuncture can ease the discomfort while waiting for an operation and perhaps even serve as an alternative to surgery . Seven patients have responded so well that at present they do not want an operation . ( USD 9000 saved per operation ) Within the context of a double blind r and omized controlled parallel trial of 2 nonsteroidal antiinflammatory drugs , we vali date d WOMAC , a new multidimensional , self-administered health status instrument for patients with osteoarthritis of the hip or knee . The pain , stiffness and physical function subscales fulfil conventional criteria for face , content and construct validity , reliability , responsiveness and relative efficiency . WOMAC is a disease-specific purpose built high performance instrument for evaluative research in osteoarthritis clinical trials OBJECTIVE To observe the clinical effect of acupuncture plus shock-wave ( SW ) intervention for osteoarthritis ( WA ) , so as to explore its practicability in clinical practice . METHODS A total of 120 cases of knee OA patients were r and omly divided into 4 groups , namely acupuncture ( acupunct ) + LFSW , acupunct + MFSW , acupunct + HFSW and routine acupunct groups , with 30 cases in each group . Xuehai ( SP 10 ) , Liangqiu ( ST 34 ) , Yanglingquan ( GB 34 ) , Xiyan ( ST 35 ) and Ashi-point were punctured with filiform needles which were manipulated with uniform reinforcing-reducing techniques for 15 - 20 min , once every other day for 7 times . In addition , these acupoints were also respectively stimulated with shock waves(10 Hz , 14 Hz and 18 Hz , pressure : 1 - 4 bar ) delivered from a DolorClastEMS therapeutic apparatus for 600 times in 3 acupunct+ SW groups . The patients ' pain response changes of the knee-joint were assessed by using visual analog scale ( VAS ) and the motility was evaluated by using a 0 - 3 grade scale . RESULTS After 7 times of treatment , the patients ' VAS scores and motility scores were significantly decreased in the acupunct+ LFSW , acupunct+ MFSW , acupunct+ HFSW and routine acupunct groups compared with their own basic values before treatment ( P < 0.01 ) , and the therapeutic effect of the acupunct+ MFSW group was significantly superior to those of the other 3 groups in reducing both VAS and motility scores ( P < 0.05 ) . Correspondingly , the Deqi sensation score of the acupunct+ MFSW group was markedly higher than those of the other 3 groups ( P < 0.05 ) . CONCLUSION Shock wave acu-puncture treatment is effective in relieving OA patients ' knee-joint pain and functional activity , and the therapeutic effect of acu- punct + 14 Hz-SW is better , which is closely with Deqi-sensation OBJECTIVE To explore a better therapy for knee osteoarthritis . METHODS One hundred cases were r and omly divided into a comprehensive group and an acupuncture group , 50 cases in each one . The comprehensive treatment of fire needles at bones combined with cupping and Tuina on local area of affected knee was applied in the comprehensive group . The Ashi points were mainly selected in the fire needles at bones therapy , once every other day . The cupping and Tuina therapy was adopted once a day . The conventional acupuncture was applied in the acupuncture group , in which Dubi ( ST 35 ) , Neixiyan ( EX-LE 4 ) , Xuehai ( SP 10 ) , Liangqiu ( ST 34 ) and so on were selected , once a day . Ten days of treatment were taken as a treatment course in both two groups , and totally 1 to 2 courses was required . The pain score of joint before and after the treatment was observed and efficacy was assessed in two groups . RESULTS Compared before the treatment , the pain score of joint after the treatment was obviously improved in two groups ( both P<0.05 ) , and the score in the comprehensive group was lower than that in the acupuncture group ( P<0.05 ) . The clinical cured rate was 38.0 % ( 19/50 ) , which was superior to 20.0 % ( 10/50 ) in the acupuncture group . CONCLUSION The comprehensive treatment of fire needles at bones combined with cupping and Tuina , considered as a better therapy for knee osteoarthritis , could improve joint pain , swelling and action function , which is superior to the conventional acupuncture OBJECTIVE To compare the difference of the efficacy on  knee osteoarthritis ( KOA )  between the combined therapy of acupuncture and moxibustion and western medication , and explore the better therapeutic method for KOA . METHODS One hundred and sixty patients were divided into a combined therapy group and a western medication group , 80 cases in each one according to the visit sequence , with the r and om number table adopted . In the combined therapy group , the main points were selected from the local painful sites , combined with the acupoints based on the syndrome differentiation and distal acupoints on the affected meridians . The lifting , thrusting or rotating technique was used and the reinforcing or reducing manipulation was applied according to the syndrome differentiation . " Duanci " or " Shuci " needling technique was used specially at the extra points and Ashi points . The needling sensation relied on the patients ' tolerance . After acupuncture , the heat-sensitive moxibustion with pure moxa stick was applied over the local painful sites around knee joint and Shenshu ( BL 23 ) to detect the heat-sensitized points . Acupuncture and moxibustion were given once every day . The treatment of 5 days made 1 session . There were 2 days at the interval between two sessions . In the western medication group , glucosamine sulfate capsules were prescribed for oral administration , 2 capsules each time , three times a day . Additionally , the joint cavity injection was combined . On the first day , sodium hyaluronate 25 mg and triamcinolone acetonide acetate 50 mg were injected . Afterwards , on the 8th , 15th , 22nd and 29th days , sodium hyaluronate injection 25 mg was used only . The treatment was for 5 weeks totally in the two groups . The efficacy was analyzed statistically in 5 weeks . The follow-up visit was conducted in 3 months and 6 months after 5 weeks treatment , respectively . The Western Ontario and Mcmaster Universities Osteoarthritis Index ( WOMAC ) and visual analogue scale ( VAS ) were adopted to assess the recovery of joint function . RESULTS The efficacy in 5 weeks of treatment was different significantly between the two groups ( P < 0.05 ) . The efficacy in the western medication group was better than that in the combined therapy group . The difference in the safety assessment was remarkable ( P < 0.01 ) . The result in the combined therapy group was superior remarkably to the western medication group . In 3-month follow-up visit after treatment , the knee joint function was not different obviously between the two groups ( P > 0.05 ) . In 6-month followup visit after treatment , the knee joint function was different obviously between the two groups ( P < 0.01 ) . The result in the combined therapy group was better remarkably than that in the western medication group . CONCLUSION The combined therapy of acupuncture and moxibustion achieves the safe and effective therapeutic effect with less adverse reactions in the treatment of KOA . The immediate effect in the combined therapy group is not so obvious as compared with the western medication , but the long-term efficacy is remarkably superior to western medication Twenty-five out- patients with chronic neck pain participated in a prospect i ve , r and omized trial of acupuncture versus placebo transcutaneous nerve stimulation . A single-blind , non-cross-over design incorporated several outcome measures in an attempt to determine any particular facet of pain that responded to acupuncture .  No significant difference between the two treatments was found either post-treatment or at follow-up . Whilst the small population studied limits the conclusions that may be drawn , these findings suggest that acupuncture may have no greater effect than that of a powerful placebo BACKGROUND To assess the efficacy of Electroacupuncture ( EA ) stimulation with high-intensity compared with low-intensity on knee osteoarthritis ( KOA ) . METHODS Participants with KOA were r and omized to either high-intensity EA group or low-intensity EA group . EA was applied unilaterally on the affected leg with the local points GB34 , ST34 , EX-LE4 , EX-LE5 , ST36 , and SP9 . The visual analogue scale ( VAS ) and the Western Ontario and McMaster Universities Osteoarthritis Index ( WOMAC ) were measured before and after participation . Plasma TNFα , IL-1β , IL-6 , and apelin levels were also assessed by enzyme immunoassay ( ELA ) before and after treatment . RESULTS Of 80 participants who consented to study participation , 77 completed the program . The patients showed a significant improvement in their pain , stiffness , and physical function on the VAS and WOMAC , accompanying with a significantly reduction in plasma levels of apelin and TNFα . Furthermore , high-intensity group exhibited statistically significant improvements in stiffness and physical function symptoms compared with low-intensity group . Plasma level of IL-6 was significantly decreased only after high-intensity EA treatment . Furthermore , apelin level was significantly inhibited in high-intensity EA group than in low-intensity EA group . CONCLUSIONS Both high- and low-intensity EA treatments alleviate the clinical symptoms of KOA patients .  High-intensity EA is more effective than low-intensity EA . Changes in plasma levels of TNFα , apelin and IL-6 may be involved in the therapeutic effect of EA on KOA Recent reports have highlighted the importance of having good evidence on the safety of acupuncture . 1 2 Sound evidence on the risks associated with acupuncture is , however , scarce.3 Our primary aim , therefore , was to describe the type and frequency of adverse events after acupuncture . A secondary aim was to examine mild transient reactions associated with  acupuncture  , some of which may indicate a positive response to treatment . The study involved a prospect i ve postal audit of treatments undertaken during a four week period in 2000 . All 1848 professional acupuncturists who were members of the British Acupuncture Council and were practising in the United Kingdom were invited to record details of adverse events and mild transient reactions after treatment . St and ardised self report forms were used . Participating practitioners also provided information on themselves , including age , sex , length of training , and years of practice . To have a Acupuncture is increasingly popular , but it is not free from risk for the patient.1 Safety is best established with prospect i ve surveys . Our aim was to ascertain the incidence of adverse events related to acupuncture treatment , as currently practised in Britain by doctors and physiotherapists . Volunteer acupuncture practitioners were recruited through journals circulated to members of the British Medical Acupuncture Society and the Acupuncture Association of Chartered Physiotherapists ( approximately 2750 members).2 A prospect i ve survey was undertaken using forms for intensive event monitoring that had been piloted previously.3 Minor adverse events were defined as “ any ill-effect , no matter how small , that is unintended and non-therapeutic , even if not unexpected . ” These events were reported every month , along with the total number of consultations . Minor or serious events that were considered to be “ significant”—“unusual , novel , dangerous , significantly inconvenient , or requiring further information”—were reported on separate forms when they occurred . Anonymous reporting was accepted . A sample size of Background There is evidence for the efficacy of acupuncture treatment in knee osteoarthritis , but it remains unclear which acupuncture modes are most effective . We evaluated the effects of trigger point acupuncture on pain and quality of life in knee osteoarthritis patients , compared with acupuncture at st and ard points , and sham acupuncture . Methods Thirty patients ( 27 women , 3 men ; aged 61–82 years ) with non-radiating knee osteoarthritis pain for at least six months and normal neurological examination were r and omised to one of three groups for the study period of 21 weeks . Each group received five acupuncture treatment sessions . The st and ard acupuncture point group ( n=10 ) received treatment at traditional acupuncture points for knee pain ; the trigger point acupuncture group ( n=10 ) received treatment at trigger points ; and the third group ( n=10 ) received sham acupuncture treatment at the trigger points . Outcome measures were pain intensity ( visual analogue scale , VAS ) and WOMAC index ( Western Ontario and McMaster Universities Arthritis Index ) . The groups were compared by the area under the curve method . Results Five patients dropped out of the study because of lack of improvement , and one patient ( in the trigger point acupuncture group ) dropped out because of deterioration of symptoms ; the remaining 24 patients were included in the analysis . After treatment , the trigger point acupuncture group reported less pain intensity on VAS than the st and ard acupuncture or sham treatment group , but both the trigger point acupuncture and st and ard acupuncture groups reported improvement of function of knee . There was a significant reduction in pain intensity between pre-treatment and five weeks after treatment for the trigger point acupuncture ( P<0.01 ) and st and ard acupuncture groups ( P<0.01 ) included in the analysis , but not for the sham treatment group . Group comparison using the area under the curves demonstrated a significant difference only between trigger point acupuncture and sham treatment groups analysed ( P<0.025 for VAS , and P<0.031 for WOMAC ) . Conclusion These results suggest that trigger point acupuncture therapy may be more effective for osteoarthritis of the knee in some elderly patients than st and ard acupuncture therapy Objective To compare the immediate effects of electroacupuncture and manual acupuncture on pain , mobility and muscle strength in patients with knee osteoarthritis . Methods Sixty patients with knee osteoarthritis , with a pain intensity of ≥2 on the pain Numerical Rating Scale , were included . The patients were r and omised into two groups : manual acupuncture and electroacupuncture . Pain intensity , degree of dysfunction ( Timed Up and Go ( TUG ) test ) , maximal voluntary isometric contraction and pressure pain threshold were assessed before and after a single session of manual acupuncture or electroacupuncture treatments . Results Both groups showed a significant reduction in pain intensity ( p<0.001 ) and time to run the TUG test after the acupuncture treatment ( p=0.005 for the manual acupuncture group and p=0.002 for the electroacupuncture group ) . There were no differences between the groups regarding pain intensity ( p=0.25 ) , TUG test ( p=0.70 ) , maximum voluntary isometric contraction ( p=0.43 ) or pressure pain threshold ( p=0.27 ) . Conclusions This study found no difference between the immediate effects of a single session of manual acupuncture and electroacupuncture  on pain , muscle strength and mobility in patients with knee osteoarthritis . Trial Registration Number RBR-9TCN2X Objective To explore the type and frequency of short term reactions associated with a single acupuncture treatment . Methods As part of recruitment to a large-scale prospect i ve survey of the safety of acupuncture , 9408 consecutive patients each completed one survey form soon after receiving treatment with acupuncture , and returned it directly to the research centre . On this form , patients were asked to report on a range of possible short term reactions relating to their most recent acupuncture treatment using a checklist of options . Results At least one short term reaction to acupuncture during or immediately after treatment was reported by 94.6 % ( CI 94.2 to 95.1 ) of patients , an average of 1.8 reactions per patient . The most common experiences reported were feeling ‘ relaxed ’ ( 79.1 % ) followed by feeling ‘ energised ’ ( 32.7 % ) . A total of 24.4 % of patients reported ‘ tiredness ’ or ‘ drowsiness ’ , with obvious implication s for safety if the patient intended to drive after treatment . ‘ Negative ’ reactions , such as pain and bruising at the site of needling , were reported by 29.7 % of patients who were more likely to be female patients ( OR 1.58 ) , patients under the age of 40 ( OR 1.62 ) , patients who had consulted their GP or hospital specialist beforeh and ( OR 1.30 ) , patients consulting their acupuncturist for the first time ( OR 1.24 ) , and patients treated by an acupuncturist with less than two years ’ experience since qualification ( OR 1.24 ) . Only 13 patients were unwilling to have acupuncture again as a result of these short term reactions . Conclusion In this large cross-sectional study , extensive patient reports showed that ‘ positive ’ reactions to acupuncture treatment were very common . Tiredness , drowsiness and a range of ‘ negative ’ reactions were also frequently reported . Almost all patients were willing to experience these reactions again OBJECTIVE To verify the clinical efficacy of shu-stream point acupuncture combined with fire needle therapy in the treatment of h and osteoarthritis . METHODS Eighty cases were r and omized into an acupuncture group ( shu-stream point acupuncture combined with fire needle therapy ) and a medication group(votalin emulgel ) . For the 42 cases in the acupuncture group , acupuncture at shu-stream points on the three yang meridians of the h and including Sanjian ( LI 3 ) , Zhongzhu ( TE 3 ) , Houxi ( SI 3 ) and fire needle at Ashi points were applied , the treatments were given once every other day , 15 times as a treatment course . For the 38 cases in the medication group , votalin emulgel was prescribed for local embrocation , twice a day , 30 days as a treatment course . The visual analogue scale ( VAS ) of arthralgia , joint function score and the duration of morning stiffness , joint tenderness , swelling were observed before and after treatment in both groups . RESULTS After two courses of clinical treatment , the VAS score of arthralgia , joint function score and the duration of morning stiffness , joint tenderness , swelling were statistically significant differences as compared with before treatment ( all P < 0.01 ) , the efficacy in the acupuncture group was superior to that in the medication group ( all P < 0.01 ) . The cured-markedly effective rate and total effective rate were 61.9 % ( 26/42 ) and 95.2 % ( 40/42 ) in the acupuncture group , and 36.8 % ( 14/38 ) and 76.3 % ( 29/38 ) in the medication group respectively , with statistically significant differences between the two groups ( both P < 0.05 ) . CONCLUSION Shu-stream point acupuncture combined with fire needle therapy achieves a significant efficacy in the treatment of h and osteoarthritis BACKGROUND In prospect i ve experimental studies in patients with asthma , it is difficult to determine whether responses to placebo differ from the natural course of physiological changes that occur without any intervention . We compared the effects of a bronchodilator , two placebo interventions , and no intervention on outcomes in patients with asthma . METHODS In a double-blind , crossover pilot study , we r and omly assigned 46 patients with asthma to active treatment with an albuterol inhaler , a placebo inhaler , sham acupuncture , or no intervention . Using a block design , we administered one each of these four interventions in r and om order during four sequential visits ( 3 to 7 days apart ) ; this procedure was repeated in two more blocks of visits ( for a total of 12 visits by each patient ) . At each visit , spirometry was performed repeatedly over a period of 2 hours . Maximum forced expiratory volume in 1 second ( FEV(1 ) ) was measured , and patients ' self-reported improvement ratings were recorded . RESULTS Among the 39 patients who completed the study , albuterol result ed in a 20 % increase in FEV(1 ) , as compared with approximately 7 % with each of the other three interventions ( P<0.001 ) . However , patients ' reports of improvement after the intervention did not differ significantly for the albuterol inhaler ( 50 % improvement ) , placebo inhaler ( 45 % ) , or sham acupuncture ( 46 % ) , but the subjective improvement with all three of these interventions was significantly greater than that with the no-intervention control ( 21 % ) ( P<0.001 ) . CONCLUSIONS Although albuterol , but not the two placebo interventions , improved FEV(1 ) in these patients with asthma , albuterol provided no incremental benefit with respect to the self-reported outcomes . Placebo effects can be clinical ly meaningful and can rival the effects of active medication in patients with asthma . However , from a clinical -management and research - design perspective , patient self-reports can be unreliable . An assessment of untreated responses in asthma may be essential in evaluating patient-reported outcomes . ( Funded by the National Center for Complementary and Alternative Medicine . ) OBJECTIVE To investigate the effectiveness of acupuncture in addition to routine care , compared with routine care alone , in the treatment of patients with chronic pain due to osteoarthritis ( OA ) of the knee or hip . METHODS In a r and omized , controlled trial , patients with chronic pain due to OA of the knee or hip were r and omly allocated to undergo up to 15 sessions of acupuncture in a 3-month period or to a control group receiving no acupuncture . Another group of patients who did not consent to r and omization underwent acupuncture treatment . All patients were allowed to receive usual medical care in addition to the study treatment . Clinical OA severity ( Western Ontario and McMaster Universities Osteoarthritis Index [ WOMAC ] ) and health-related quality of life ( Short Form 36 ) were assessed at baseline and after 3 months and 6 months . RESULTS Of 3,633 patients ( mean + /- SD age 61.8 + /- 10.8 years ; 61 % female ) , 357 were r and omized to the acupuncture group and 355 to the control group , and 2,921 were included in the nonr and omized acupuncture group . At 3 months , the WOMAC had improved by a mean + /- SEM of 17.6 + /- 1.0 in the acupuncture group and 0.9 + /- 1.0 in the control group ( 3-month scores 30.5 + /- 1.0 and 47.3 + /- 1.0 , respectively [ difference in improvement 16.7 + /- 1.4 ; P < 0.001 ] ) . Similarly , quality of life improvements were more pronounced in the acupuncture group versus the control group ( P < 0.001 ) . Treatment success was maintained through 6 months . The changes in outcome in nonr and omized patients were comparable with those in r and omized patients who received acupuncture . CONCLUSION These results indicate that acupuncture plus routine care is associated with marked clinical improvement in patients with chronic OA-associated pain of the knee or hip BACKGROUND A problem acupuncture research has to face is the concept of a control group . If , in control groups , non-acupoint needling is done , physiological acupuncture effects are implied . Therefore the effects shown in this group are often close to those shown in the acupuncture group . In other trials , control groups have received obviously different treatments , such as transcutaneous electrical nervous stimulation or TENS-laser treatment ; it is not clear if the effects of acupuncture are due only to the psychological effects of the treatment . METHODS We developed a placebo acupuncture needle , with which it should be possible to simulate an acupuncture procedure without penetrating the skin . In a cross-over experiment with 60 volunteers we tested whether needling with the placebo needle feels any different from real acupuncture . FINDINGS Of 60 volunteers , 54 felt a penetration with acupuncture  ( mean visual analogue scale [ VAS ] 13.4 ; SD 10.58 ) and 47 felt it with placebo ( VAS 8.86 ; SD 10.55 ) , 34 felt a dull pain sensation ( DEQI ) with acupuncture and 13 with placebo . None of the volunteers suspected that the needle may not have penetrated the skin . INTERPRETATION The placebo needle is sufficiently credible to be used in investigations of the effects of acupuncture OBJECTIVE To determine whether demographic , medical history , or arthritis assessment data may influence outcome and rate of decay for patients with osteoarthritis treated with acupuncture .  DESIGN Seventy-three persons with symptomatic osteoarthritis of the knee were recruited for this r and omized controlled trial . Both treatment and crossover control groups received acupuncture treatments twice weekly for 8 weeks . Patients self-scored on the Western Ontario and McMaster Universities Osteoarthritis Index ( WOMAC ) and the Lequesne Algofunctional Index at baseline and 4 , 8 , and 12 weeks . Sample size for this outcome analysis was 60 patients at 4 weeks , 58 at 8 weeks , and 52 at 12 weeks . RESULTS Patients ' scores on both indexes improved at 4 , 8 , and 12 weeks . Scores were stable regardless of the baseline severity of the osteoarthritis . Despite some decay in outcomes at week 12 , measures were significantly improved over baseline . With WOMAC scores partitioned into equal quartiles , a strong effect on outcome was apparent at 12 weeks ( 4 weeks after treatment ) related to initial WOMAC scores . The group with the least disability and pain rebounded to original levels to a greater degree than did those who initially were more disabled . The more disabled groups retained the benefits of acupuncture treatment through the 12-week period . CONCLUSION Acupuncture for patients with osteoarthritis of the knee may best be used early in the treatment plan , with a method ical decrease in frequency in treatment once the acute treatment period is completed to avoid a rebound effect . Demographic and medical history data were not mediating variables Background Knee osteoarthritis is a chronic disease associated with significant morbidity and economic cost . The efficacy of acupuncture in addition to traditional physical therapy has received little study . Objective The objective of this study was to compare the efficacy and safety of integrating a st and ardized true acupuncture protocol versus nonpenetrating acupuncture into exercise-based physical therapy ( EPT ) . Methods This was a r and omized , double-blind , controlled trial at 3 physical therapy centers in Philadelphia , PA . We studied 214 patients ( 66 % African Americans ) with at least 6 months of chronic knee pain and x-ray – confirmed Kellgren scores of 2 or 3 . Patients received 12 sessions of acupuncture directly following EPT over 6 to 12 weeks . Acupuncture was performed at the same 9 points dictated by the traditional Chinese “ Bi ” syndrome approach to knee pain , using either st and ard needles or Streitberger non – skin-puncturing needles . The primary outcome was the proportion of patients with at least a 36 % improvement in Western Ontario and McMaster Universities Osteoarthritis Index score at 12 weeks . Results Both treatment groups showed improvement from combined therapy with no difference between true ( 31.6 % ) and nonpenetrating acupuncture ( 30.3 % ) in Western Ontario and McMaster Universities Osteoarthritis Index response rate ( P = 0.5 ) or report of minor adverse events . A multivariable logistic regression prediction model identified an association between a positive expectation of relief from acupuncture and reported improvement . No differences were noted by race , sex , or age . Conclusions Puncturing acupuncture needles did not perform any better than nonpuncturing needles integrated with EPT . Whether EPT , acupuncture , or other factors accounted for any improvement noted in both groups could not be determined in this study . Expectation for relief was a predictor of reported benefit OBJECTIVE The purpose of this preliminary study was to examine whether collateral meridian ( CM ) therapy was feasible in treating  knee osteoarthritis ( OA ) pain .  METHODS Twenty-eight patients with knee OA and knee pain were r and omly allocated to 2 groups . The CM group patients received CM therapy , whereas the control patients received placebo treatment for knee pain relief . Patients in the CM group received 2 CM treatments weekly for 3 weeks . The outcome measures were pain intensity on a visual analog scale , and knee function was determined using the Western Ontario and McMaster Universities Osteoarthritis Index . RESULTS In the CM group , the posttreatment visual analog scale and Western Ontario and McMaster Universities Osteoarthritis Index scores were lower than those of the control group ; a significant reduction in pain intensity ( P = .02 , P = .01 , respectively ) and improvement in knee function ( P = .04 , P = .03 , respectively ) were shown in the CM group at the second and third week . CONCLUSION Collateral meridian therapy may be feasible and effective for knee OA pain relief and knee function recovery . Therefore , additional r and omized control trials are warranted OBJECTIVE To evaluate the clinical efficacy of YANG 's pricking-cupping therapy for knee osteoar thritis ( KOA ) . Methods This was a multi-center r and omized parallel controlled trial . One hundred and seventy one patients with KOA were r and omly allocated to a pricking-cupping group ( 89 cases ) and a conventional acu puncture group ( 82 cases ) . Neixiyan ( EX-LE 4 ) , Dubi ( ST 35 ) and ashi points were selected in the two groups . Patients in the pricking-cupping group were treated with YANG 's pricking-cupping therapy ; the seven-star needles were used to perform pricking at acupoints , then cupping was used until slight bleeding was observed . Patients in the conventional acupuncture group were treated with semi-st and ardized filiform needle therapy . The treatment was given for 4 weeks ( from a minimum of 5 times to a maximum of 10 times ) . The follow-up visit was 4 weeks . The Western Ontario and McMaster Universities Osteoarthritis Index ( WOMAC ) and the visual analogue scale ( VAS ) were adopted for the efficacy assessment s. RESULTS The pain score , stiffness score , physical function score and total score of WOMAC were all reduced after 4-week treatment and during follow-up visit in the two groups ( all P<0 . 0001 ) . Except that the difference of stiffness score between the two groups was not significant after 4-week treatment ( P>0 . 05 ) , each score and total score of WOMAC in the pricking-cupping group were lower than those in the conventional acupuncture group after 4-week treatment and during follow-up visit ( P<0 . 0001 , P<0 . 01 ) . After 2-week treatment , 4-week treatment and during follow-up visit , the VAS was all reduced compared with that before treatment ( all P<0 . 0001 ) ; with the increase of the treatment , the reducing trend of VAS was more significant ( P<0 . 0001 ) . The scores of VAS in the pricking-cupping group were lower than those in the conventional acupuncture group after 4-week treatment and during follow-up visit ( P < 0 . 01 , P < 0 . 0001 ) . CONCLUSION The YANG 's pricking-cupping and conventional acupuncture therapy can both significantly improve knee joint pain and function in patients with KOA , which are relatively safe . The pricking  cupping therapy is superior to conventional acupuncture with the identical selection of acupoints BACKGROUND In clinical trials , at the group level , results are usually reported as mean and st and ard deviation of the change in score , which is not meaningful for most readers . OBJECTIVE To determine the minimal clinical ly important improvement ( MCII ) of pain , patient 's global assessment of disease activity , and functional impairment in patients with knee and hip osteoarthritis ( OA ) . METHODS A prospect i ve multicentre 4 week cohort study involving 1362 out patients with knee or hip OA was carried out . Data on assessment of pain and patient 's global assessment , measured on visual analogue scales , and functional impairment , measured on the Western Ontario McMaster Universities Osteoarthritis Index ( WOMAC ) function subscale , were collected at baseline and final visits . Patients assessed their response to treatment on a five point Likert scale at the final visit . An anchoring method based on the patient 's opinion was used . The MCII was estimated in a subgroup of 814 patients ( 603 with knee OA , 211 with hip OA ) . RESULTS For knee and hip OA , MCII for absolute ( and relative ) changes were , respectively , ( a ) -19.9 mm ( -40.8 % ) and -15.3 mm ( -32.0 % ) for pain ; ( b ) -18.3 mm ( -39.0 % ) and -15.2 mm ( -32.6 % ) for patient 's global assessment ; ( c ) -9.1 ( -26.0 % ) and -7.9 ( -21.1 % ) for WOMAC function subscale score . The MCII is affected by the initial degree of severity of the symptoms but not by age , disease duration , or sex . CONCLUSION Using criteria such as MCII in clinical trials would provide meaningful information which would help in interpreting the results by expressing them as a proportion of improved patients OBJECTIVE To estimate minimal clinical ly important differences ( MCID ) of effects measured by the Western Ontario and McMaster Universities Osteoarthritis Index ( WOMAC ) in patients with osteoarthritis ( OA ) of the lower extremities undergoing a comprehensive inpatient rehabilitation intervention . METHODS A prospect i ve cohort study assessed patients ' health by the WOMAC at baseline ( entry into the clinic ) and at the 3 month followup , and by a transition question naire asking about the change of " health in general related to the OA joint " during that time period . The WOMAC section score differences between the " equal " group and the " slightly better " and " slightly worse " groups result ed in the MCID for improvement and for worsening . RESULTS In total 192 patients were followed up . The MCID for improvement ranged from 0.80 to 1.01 points on the continuous WOMAC numerical rating scale from 0 to 10 , reflecting changes of 17 to 22 % of baseline scores . The MCID for worsening conditions ranged from 0.29 ( 6 % ) to 1.03 points ( 22 % ) . In the transition reply subjectively unchanged patients reported a " pessimistic bias " of 0.35 to 0.51 points , except for the stiffness section . Both MCID and pessimistic bias showed regression to the mean and baseline dependency . CONCLUSION The assessment of MCID using the transition method is a heuristic and valid strategy to detect particular rehabilitation effects in patients with OA of the lower extremities with the use of the WOMAC , and it is worth implementing . The size of the MCID and of the systematic bias is comparable to that assessed by other methods and in other therapeutic setting Objective To investigate the benefit of adding acupuncture to a course of advice and exercise delivered by physiotherapists for pain reduction in patients with osteoarthritis of the knee . Design Multicentre , r and omised controlled trial . Setting 37 physiotherapy centres accepting primary care patients referred from general practitioners in the Midl and s , United Kingdom . Participants 352 adults aged 50 or more with a clinical diagnosis of knee osteoarthritis . Interventions Advice and exercise ( n=116 ) , advice and exercise plus true acupuncture ( n=117 ) , and advice and exercise plus non-penetrating acupuncture ( n=119 ) . Main outcome measures The primary outcome was change in scores on the Western Ontario and McMaster Universities osteoarthritis index pain subscale at six months . Secondary outcomes included function , pain intensity , and unpleasantness of pain at two weeks , six weeks , six months , and 12 months . Results Follow-up rate at six months was 94 % . The mean ( SD ) baseline pain score was 9.2 ( 3.8 ) . At six months mean reductions in pain were 2.28 ( 3.8 ) for advice and exercise , 2.32 ( 3.6 ) for advice and exercise plus true acupuncture , and 2.53 ( 4.2 ) for advice and exercise plus non-penetrating acupuncture . Mean differences in change scores between advice and exercise alone and each acupuncture group were 0.08 ( 95 % confidence interval −1.0 to 0.9 ) for advice and exercise plus true acupuncture and 0.25 ( −0.8 to 1.3 ) for advice and exercise plus non-penetrating acupuncture . Similar non-significant differences were seen at other follow-up points . Compared with advice and exercise alone there were small , statistically significant improvements in pain intensity and unpleasantness at two and six weeks for true acupuncture and at all follow-up points for non-penetrating acupuncture . Conclusion The addition of acupuncture to a course of advice and exercise for osteoarthritis of the knee delivered by physiotherapists provided no additional improvement in pain scores . Small benefits in pain intensity and unpleasantness were observed in both acupuncture groups , making it unlikely that this was due to acupuncture needling effects . Trial registration Current Controlled Trials IS RCT N88597683 OBJECTIVE To study the synergistic effects of electroacupuncture on the treatment of knee osteoarthritis after arthroscopic debridement . METHODS From May 2008 to July 2010 , 78 patients with knee osteoarthritis were r and omly divided into two groups . There were 42 patients in the experimental group , including 16 males and 26 females , ranging in age from 41 to 63 years , with an average of ( 53.62 + /- 6.53 ) years ; the disease course ranged from 8 to 24 months , with an average of ( 10.35 + /- 6.42 ) months . The patients were treated with arthroscopic debridement combined with electroacupuncture after operation . There were 36 patients in the control group , including 14 males and 22 females , ranging in age from 40 to 62 years , with an average of ( 54.34 + /- 7.67 ) years ; the disease course ranged from 6 to 25 months , with an average of ( 11.94 + /- 5.13 ) months . Those patients were treated only with arthroscopic debridment . All the patients performed isometric quadriceps femoris contraction exercise and knee flexion and extension activities after operation . The visual analog scale(VAS ) score and Lysholm knee score were used to evaluate the therapeutic effects . RESULTS All the patients were followed up , and the duration ranged from 12 to 30 months , with an average of 15.6 months . At the final follow-up , VAS score was significantly decreased , and the Lysholm score , except for the item dem and ing for support , significantly increased , compared with those before surgery respectively in both groups . There was significant difference in VAS score between two groups after treatment . As to Lysholm score , there were significant differences in limp , pain , swelling , stair activity and squat , but there were no significant differences in items of interlocking and instability between two groups after treatment . CONCLUSION Electroacupuncture can effectively improve the clinical symptoms and knee joint 's motor function of knee joints in patients with knee osteoarthritis , as well as the synergistic effects on the treatment of knee osteoarthritis after arthroscopic debridement , leading to a much better long-term therapeutic effect with respect of improving the function of knee joint . This therapy , combined with traditional Chinese medicine and Western Medicine , is worth of clinical application in the treatment of knee osteoarthritis OBJECTIVES The effectiveness of acupuncture treatment  in patients with osteoarthritis of the hip was tested . DESIGN This is a prospect i ve , r and omized , controlled , patient- and investigator-blinded clinical trial . PATIENTS AND SETTING The study was performed at a university department for physical medicine and rehabilitation . Sixty-seven patients were separated into two treatment groups . INTERVENTIONS Group 1 ( treatment ) had traditional needle placement and manipulation , whereas in group 2 ( control ) needles were placed away from classic positions and not manipulated . In both groups needles were placed within the L2 to L5 dermatomes . Outcome parameters were : pain ( VAS ) , functional impairment ( hip score ) , activity in daily life ( ADL ) and overall satisfaction before treatment , and 2 weeks and 2 months after treatment . RESULTS For all parameters there was a significant improvement versus baseline in both groups 2 weeks and 2 months following treatment , but no significant difference between the two treatment groups . CONCLUSIONS We conclude from these results that needle placement in the area of the affected hip is associated with improvement in the symptoms of osteoarthritis . It appears to be less important to follow the rules of traditional acupuncture techniques Thirty patients with cervical spine pain syndromes persisting a mean of 8 years were assigned r and omly into equal treatment and control groups . After 12 weeks , 12 of 15 ( 80 % ) of the treated group felt improved , some dramatically , with a mean 40 % reduction of pain score , 54 % reduction of pain pills , 68 % reduction of pain hours per day and 32 % less limitation of activity . Two of 15 ( 13 % ) of the control group reported slight improvement after 12.8 weeks . The control group had a mean 2 % worsening of the pain score , 10 % reduction in pain pills , no lessening of pain hours and 12 % less limitation of activity OBJECTIVE To observe the difference in the therapeutic effects on  knee osteoarthritis ( KOA )  among auricular electroacupuncture therapy plus isolated moxibustion with Lingxian herbal paste ( combined therapy ) , electroacupuncture ( EA ) and TDP irradiation . METHODS Eighty-nine cases were r and omized into three groups . In the combined therapy group ( 30 cases ) , the auricular electroacupuncture therapy was adopted together with the isolated moxibustion with Lingxian herbal paste . The auricular points were xi ( AH4 ) , pizhixia ( AT4 ) , shenmen ( TF4 ) , etc . The Lingxian herbal paste was applied at Yanglingquan ( GB 34 ) , Dubi ( ST 35 ) , Zusanli ( ST 36 ) , Neixiyan ( EX-LE 4 ) , Heding ( EX-LE 2 ) and Ashi points . In EA group ( 29 cases ) , EA was applied at the acupoints that were same as those in the isolated moxibustion with Lingxian herbal paste . In TDP group ( 30 cases ) , TDP irradiation was given at the affected knee . The treatment was given once every day , 10 treatments made one session and there was 1 week at the interval among sessions . Totally , 3 sessions of treatment were required . KOA clinical symptom and physical sign score and the single item pain symptom score of Lequesne index were observed before treatment and 1 week after treatment in the patients of each group separately . The efficacies were compared among the three groups . RESULTS One week after treatment , the total score of symptoms and physical signs of the patients in each group was reduced significantly as compared with that before treatment ( all P < 0.05 ) . The improvements in the symptoms and physical signs in the combined therapy group were better than those in the other two groups ( 1.50 + /- 1.57 vs 2.52 + /- 1.82 , 2.63 + /- 1.97 , both P < 0.05 ) . The improvement in pain in the combined therapy group was also better than that in the other two groups ( 2.37 + /- 0.81 vs 2.83 + /- 0.92 , P < 0.05 ; 2.37 + /- 0.81 vs 3.03 + /- 0.77 , P < 0.01 ) . The curative rate in the combined therapy group was 40.0 % ( 12/30 ) , which was higher than 17.2 % ( 5/29 ) in EA group and 20.0 % ( 6/30 ) in TDP group separately ( both P < 0.01 ) . The overall efficacy in the combined therapy group was superior to the other two groups ( P < 0.05 ) . CONCLUSION The auricular electroacupuncture therapy plus isolated moxibustion with Lingxian herbal paste is advantageous at the total score of the symptoms and physical signs and the overall efficacy in the patients of KOA as compared with EA at the local acupoints and local TDP irradiation Objectives : The aim of the study was to evaluate the therapeutic effect of electro-acupuncture ( EA ) and hydrotherapy , both in combination with patient education or with patient education alone , in the treatment of osteoarthritis in the hip . Methods : Forty-five patients , aged 42–86 years , with radiographic changes consistent with osteoarthritis in the hip , pain related to motion , pain on load , and ache were chosen . They were r and omly allocated to EA , hydrotherapy , both in combination with patient education , or patient education alone . Outcome measures were the disability rating index ( DRI ) , global self-rating index ( GSI ) , and visual analogue scale ( VAS ) . Assessment s were done before the intervention and immediately after the last treatment and 1 , 3 , and 6 months after the last treatment . Results : Pain related to motion and pain on load was reduced up to 3 months after last the treatment in the hydrotherapy group and up to 6 months in the EA group . Ache during the day was significantly improved in both the EA and hydrotherapy group up to 3 months after the last treatment . Ache during the night was reduced in the hydrotherapy group up to 3 months after the last treatment and in the EA group up to 6 months after . Disability in functional activities was improved in EA and hydrotherapy groups up to 6 months after the last treatment . Quality of life was also improved in EA and hydrotherapy groups up to 3 months after the last treatment . There were no changes in the education group alone . Discussion : In conclusion , EA and hydrotherapy , both in combination with patient education , induce long-lasting effects , shown by reduced pain and ache and by increased functional activity and quality of life , as demonstrated by differences in the pre- and post-treatment assessment
BACKGROUND Hip osteoarthritis ( OA ) is a major cause of pain and functional limitation .
Few hip OA treatments have been evaluated for safety and effectiveness .
Acupuncture is a traditional Chinese medical therapy which aims to treat disease by inserting very thin needles at specific points on the body .
OBJECTIVES To assess the benefits and harms of acupuncture in patients with hip OA .