Acupuncture treatment for chronic knee pain: a systematic review

Objectives. To evaluate the effects of acupuncture on pain andfunction in patients with chronic knee pain. Methods. Systematic review and meta-analysis of randomized controlledtrials of adequate acupuncture. Computerized databases and referencelists of articles were searched in June 2006. Studies were selectedin which adults with chronic knee pain or osteoarthritis ofthe knee were randomized to receive either acupuncture treatmentor a control consisting of sham (placebo) acupuncture, othersham treatments, no additional intervention (usual care), oran active intervention. The main outcome measures were short-termpain and function, and study validity was assessed using a modificationof a previously published instrument. Results. Thirteen RCTs were included, of which eight used adequateacupuncture and provided WOMAC outcomes, so were combined inmeta-analyses. Six of these had validity scores of more than50%. Combining five studies in 1334 patients, acupuncture wassuperior to sham acupuncture for both pain (weighted mean differencein WOMAC pain subscale score = 2.0, 95% CI 0.57–3.40)and for WOMAC function subscale (4.32, 0.60–8.05). Thedifferences were still significant at long-term follow-up. Acupuncturewas also significantly superior to no additional intervention.There were insufficient studies to compare acupuncture withother sham or active interventions. Conclusions. Acupuncture that meets criteria for adequate treatmentis significantly superior to sham acupuncture and to no additionalintervention in improving pain and function in patients withchronic knee pain. Due to the heterogeneity in the results,however, further research is required to confirm these findingsand provide more information on long-term effects. KEY WORDS: Acupuncture, Systematic review, Meta-analysis, Chronic knee pain, Osteoarthritis, WOMAC, FunctionSubmitted 4 July 2006; revised version accepted 7 November 2006.