Acupuncture as a Pain Treatment for Patients with Knee Arthritis

Abstract 

A mainstay of the traditional Chinese medicine, acupuncture is proposed to be one of the remedies to pain for patients with knee Arthritis. Purpose: this paper was categorical to the examination of literature and evidence that resides in the capability of acupuncture as a treatment for pain in patients with knee arthritis. The paper proposed to underscore the evidence within the literature as well as medical practice that supports the treatment of pain caused by knee arthritis through the use of acupuncture. Method: with the aim of evaluation of available evidence on acupuncture and its treatment efficacy to pain caused by knee arthritis, this paper employed a literature investigation strategy. Therein, through evaluation of studies, experiments as well as relevant literature, the author was able to underscore the use of acupuncture. The study undertaken in the paper uses a review of secondary data collected in differing experiments, human trials, purposive studies as well as general practice observations literature to achieve the objectives of the paper. Results: various studies that explore acupuncture from the perspective of real acupuncture and sham acupuncture indicate a significant pain improvement on real acupuncture as opposed to the placebo. From another perspective of comparison of acupuncture and conventional medicine in pain treatment, little differences were identifiable through the measure of the pain index. The results lead to an implication of the efficacy and confirmation of acupuncture as a treatment method for patients with knee arthritis. 

Keywords: acupuncture, arthritis, conventional medicine, knee, osteoarthritis, pain 

Introduction 

Arthritis is a degenerative disease whose part of its symptoms present themselves in the form of pain in the joints. Despite having different causal elements, both rheumatoid and osteoarthritis present almost similar symptoms of pain in joints. However, pain in the knee joint is the most common in arthritis. Arthritis is a chronic disease with no known cure; the treatment procedures prescribed to patients in this condition are geared towards pain alleviation. Acupuncture with its origin from the traditional Chinese medicine has been cited to relieve chronic pain such as that proficient by patients suffering from arthritis (Harris, 2009, pp.1078). Acupuncture procedure is based on the body physiology on health attainment through the flow of vital energy. Meridians that are explicit body tracks through which the vital energy, chi, flows through. From this perspective, health deterioration is caused when the meridians are blocked (Scharf, 2006, pp.12). Acupuncture is therefore administered in the effort to unblock the obstruction residing in the meridians. The stimulation achieved from acupuncture increases the flow of natural body pain killers which relieve pain from the intended body part (Zhao, 2014, pp 133). The realization resulted in arthritis patients seeking acupuncture as an alternative method to manage pain in the knees. 

Nonetheless, there are existing conflicting evidence that question the effectiveness of acupuncture as a form of treatment in knee arthritis. Acupuncture being a nonconventional treatment procedure is applied selectively at the discretion of the patient. Therefore, there exists little literature and studies carried out purposively to provide light in the subject matter. Osteoarthritis is the most proliferate form of arthritis, and therefore a large proportion of treatment and studies are indicative of the progress in knee osteoarthritis (Ezzo, 2001 pp.819). The purpose of this paper is to review the literature present as indicated by the studies and experiments as well as practical observations from practitioners in the aim to evaluate the effectiveness of acupuncture for pain relieve (White, 2007 pp.385). To achieve that objective, the review will be guided by the fundamental questions: how effective is acupuncture as a form of treatment? And how effective is that form of treatment in pain alleviation in knee arthritis? 

Method 

The study takes the progression of literature and evidence review on the subject matter. Therein, the researcher applies the use of analytical synthesis from the various studies’ results and experiments undertaken and relevant to the subject matter. Therein, the researcher processes the various article information and studies on knee arthritis body physiology and treatment mechanisms. Secondly, the researcher categorically analyses data from articles and studies on the Chinese traditional medicine in acupuncture practice. Thirdly, the researcher categorically analyses studies experiments conducted in the effort to underscore the relationship between acupuncture and pain relief from the knees on arthritis condition. This analytical analysis is conducted from the perspectives of medical practitioners in varying ideologies, the western perspective, and the Chinese traditional medicine. 

The analysis context of the literature follows a book research and the criteria for the analysis of the articles is as follows; first all the articles chosen are peer reviewed articles found and accessible online in the databases of academic research and medical journals. Google scholar was used as the main search database since the provided material is easily accessible online. The choices of journals under which the articles are published have made significant contributions in the medical science which is the basis of criteria. Among the journals sampled include; 

The Lancet, 

Annals Of Internal Medicine, 

Neuroimage , 

Arthritis Care And Research, 

Osteoarthritis And Cartilage , 

Rheumatology (Oxford, England). 

The search criteria included key words for search that include; 

acupuncture and chronic arthritis pain treatment, 

traditional Chinese acupuncture treatment and arthritis of the knee, 

Sham acupuncture and pain treatement of arthritis of the knee. 

non-penetrating sham acupuncture 

These search result produced over 37,000 hits, tittles and abstracts from google scholar and Pubmed. Through the use of the inclusion and exclusion criterea, 15 artilcle samples from the databases were sampled. 10 articles wre read in full of which they were retained as they fit the selection criterion that included: written in English, studies conducted and articles written from 2000 through 2017, the methods used in the studies reflected ethical considerations. Nonetheless, there is an exception of one article referred to but published in 1995 for the reason that its scope is well verifiable with the subject matter in the investigation. A significant number of the articles read and reviewed for information were from direct clinical trials, medical studies as well as traditional acupuncture practice. 

Results 

Through the analysis of literature and studies on the efficiency of acupuncture to relieve pain caused by knee arthritis, the researcher identified varying data. For instance, in a randomised trial conducted by Dr. C. Witt on acupuncture in patients with osteoarthritis of the knee, there was significant acknowledgeable evidence on the use of acupuncture. Inset, the trials used ancillary outcome measures to analyze data where a significant effluent results were identifiable from patients who received acupuncture as compared to those from the minimal acupuncture group as well as the control group (Witt et al. 2005 pp.138). In this study, the pain index score was identified to have decreased by at least fifty percent for fifty-two percent of the group that received acupuncture and twenty-eight percent in the group that received minimal acupuncture and three percent for the control group. However, with the design of the study, over time, the difference was minimalized between the three groups at the end of the study. 

In another randomized but controlled study, the results are relatively differing dependent on the mode of the study. Inset, the pain levels through WOMAC index was applied; there was a noticeable reduction in pain by at least forty percent of the patients who received true acupuncture (Berman, 2004, pp.902). However, in the progress of the study, the data indicated a minimalist difference between the groups that participated in the experiment. In other large-scale studies to measure the efficiency of acupuncture, there was an indication of improvement of pain reduction that was statistically significant. Nonetheless, as the experiment progressed through time, the improvement in pain reduction was minimal in comparison to own baseline data (Suarez ‐ Almazor, 2010, pp.1230). Significant studies conducted in comparison with control groups of sham acupuncture and real acupuncture had a significant indication of pain alleviation improvement up to a certain point in the trial for those receiving real acupuncture. 

Nonetheless, other studies approached the level of efficacy of acupuncture not from control groups but from the perspective of other existing conventional treatment. In such studies, the differences were reported to mild with little statistical significance (Fink, 2001 pp.83). The results, however, indicated the varying data in which in some cases there were noticeable differences in favor of both acupuncture and conventional medicine in pain alleviation. From the perspective of the practitioners, other studies indicated the relevance of patient comfort and happiness to use as a variable in the efficacy of acupuncture (Hinman, 2014 pp.1316). From this perspective, there was significance noticeable of the efficiency of acupuncture in comparison to conventional medicine. 

Discussions 

The results of this study indicate the various patterns that arise from the various experiments and trails conducted to measure the efficacy of acupuncture in the pain treatment of knee arthritis (Jubb, 2008 pp.69). Following an analytical review of the studies, acupuncture based on the Chinese tradition is demonstrated to be a safe practice. The results also indicate deferring perceptions depending on the design of the study they take place. From the perspective of patients with great knee pains caused by arthritis, acupuncture can either be used as a treatment protocol on its own or in complementary with conventional medicine (Berman, 1995 Pp. 140). The perspective is informed by the acknowledgment of a pattern of deteriorating pain reduction on acupuncture. The degree of pain relieve when using acupuncture is dependent on the initial level of pain. Nevertheless, with almost all studies indicating an almost fifty percent positive response in pain reduction for patients receiving acupuncture is a positive review for the practice (Wang, 2008, pp.18). With the significant improvement in pain alleviation observed from different studies, acupuncture is determined to be a form of treatment for pain in knee arthritis (Manheimer, 2007 pp.870). The analytical study conducted in this paper is however limited to the constraints of availability of specific data used in the studies reviewed. Being pure, analytical the study is limited to the non-inclusiveness of primary data but rather synthesized data contaminated with perspectives and opinions of authors. 

Conclusions 

Arthritis is a chronic disease, and therefore pain management forms the treatment protocol through which a patient can explore. The effectiveness of acupuncture is therefore identifiable through the achievement of the major goals of arthritis treatment that is to the reduce pain suffered by the patient. Under such standards, therefore, acupuncture is an effective treatment procedure for knee arthritis. Similarly, the studies that compared its effectiveness with conventional medicine indicated little differences within efficacy model of the treatments. Therein, acupuncture despite being an exotic mode of treatment from Chinese traditional medicine stands out as a formidable form of treatment. Nevertheless, the practice is fairly new in the spheres of modern medicine, for its application to be considered efficient in treatment for arthritis, more purposive studies and research ought to be conducted. There exist huge knowledge gaps on the utility of body stimulation that is need of exploration to determine the efficacy and application of acupuncture as a form of treatment for knee arthritis pain reduction. 

Reference list 

Harris, R.E., Zubieta, J.K., Scott, D.J., Napadow, V., Gracely, R.H. and Clauw, D.J., 2009. Traditional Chinese acupuncture and placebo (sham) acupuncture are differentiated by their effects on μ-opioid receptors (MORs).  Neuroimage ,  47 (3), pp.1077-1085. 

Scharf, H., Mansmann, U., Streitberger, K., Witte, S., Krämer, J., Maier, C., Trampisch, H. & Victor, N. 2006, "Acupuncture and knee osteoarthritis: a three-armed randomized trial",  Annals of internal medicine,  vol. 145, no. 1, pp. 12. 

Zhao, L., Cheng, K., Wang, L., Wu, F., Deng, H., Tan, M., Lao, L. and Shen, X., 2014. Effectiveness of moxibustion treatment as adjunctive therapy in osteoarthritis of the knee: a randomized, double-blinded, placebo-controlled clinical trial.  Arthritis research & therapy ,  16 (3), p.R133. 

Ezzo, J., Hadhazy, V., Birch, S., Lao, L., Kaplan, G., Hochberg, M. and Berman, B., 2001. Acupuncture for osteoarthritis of the knee: a systematic review.  Arthritis & Rheumatology ,  44 (4), pp.819-825. 

White, A., Foster, N.E., Cummings, M. & Barlas, P. 2007, "Acupuncture treatment for chronic knee pain: a systematic review",  Rheumatology (Oxford, England),  vol. 46, no. 3, pp. 384-390. 

Witt, C., Brinkhaus, B., Jena, S., Linde, K., Streng, A., Wagenpfeil, S., Hummelsberger, J., Walther, H., Melchart, D. & Willich, S. 2005, "Acupuncture in patients with osteoarthritis of the knee: a randomised trial",  The Lancet,  vol. 366, no. 9480, pp. 136-143. 

Berman, B.M., Lao, L., Langenberg, P., Lee, W.L., Gilpin, A.M.K. & Hochberg, M.C. 2004, "Effectiveness of acupuncture as adjunctive therapy in osteoarthritis of the knee: a randomized, controlled trial",  Annals of internal medicine,  vol. 141, no. 12, pp. 901 

Suarez ‐ Almazor, M.E., Looney, C., Liu, Y., Cox, V., Pietz, K., Marcus, D.M. & Street, R.L. 2010, "A randomized controlled trial of acupuncture for osteoarthritis of the knee: Effects of patient ‐ provider communication",  Arthritis Care & Research,  vol. 62, no. 9, pp. 1229-1236. 

Fink, M.G., Wipperman, B. and Gehrke, A., 2001. Non-specific effects of traditional Chinese acupuncture in osteoarthritis of the hip.  Complementary therapies in medicine ,  9 (2), pp.82-89. 

Hinman, R.S., McCrory, P., Pirotta, M., Relf, I., Forbes, A., Crossley, K.M., Williamson, E., Kyriakides, M., Novy, K., Metcalf, B.R., Harris, A., Reddy, P., Conaghan, P.G. & Bennell, K.L. 2014, "Acupuncture for Chronic Knee Pain: A Randomized Clinical Trial",  JAMA,  vol. 312, no. 13, pp. 1313-1322. 

Jubb, R.W., Tukmachi, E.S., Jones, P.W., Dempsey, E., Waterhouse, L. and Brailsford, S., 2008. A blinded randomised trial of acupuncture (manual and electroacupuncture) compared with a non-penetrating sham for the symptoms of osteoarthritis of the knee.  Acupuncture in Medicine ,  26 (2), p.69. 

Berman, B.M., Lao, L., Greene, M., Anderson, R.W., Wong, R.H., Langenberg, P. and Hochberg, M.C., 1995. Efficacy of traditional Chinese acupuncture in the treatment of symptomatic knee osteoarthritis: a pilot study.  Osteoarthritis and Cartilage ,  3 (2), pp.139-142. 

Wang, T., Zhang, Q., Xue, X. and Yeung, A., 2008. A systematic review of acupuncture and moxibustion treatment for chronic fatigue syndrome in China.  The American journal of Chinese medicine ,  36 (01), pp.1-24. 

Manheimer, E., Linde, K., Lao, L., Bouter, L.M. & Berman, B.M. 2007, "Meta-analysis: Acupuncture for Osteoarthritis of the Knee",  Annals of Internal Medicine,  vol. 146, no. 12, pp. 868-877. 

Articles retrieved from google scholar 

Suarez ‐ Almazor, M.E., Looney, C., Liu, Y., Cox, V., Pietz, K., Marcus, D.M. & Street, R.L. 2010, "A randomized controlled trial of acupuncture for osteoarthritis of the knee: Effects of patient ‐ provider communication",  Arthritis Care & Research,  vol. 62, no. 9, pp. 1229-1236. 

Hinman, R.S., McCrory, P., Pirotta, M., Relf, I., Forbes, A., Crossley, K.M., Williamson, E., Kyriakides, M., Novy, K., Metcalf, B.R., Harris, A., Reddy, P., Conaghan, P.G. & Bennell, K.L. 2014, "Acupuncture for Chronic Knee Pain: A Randomized Clinical Trial",  JAMA,  vol. 312, no. 13, pp. 1313-1322. 

Ezzo, J., Hadhazy, V., Birch, S., Lao, L., Kaplan, G., Hochberg, M. and Berman, B., 2001. Acupuncture for osteoarthritis of the knee: a systematic review.  Arthritis & Rheumatology ,  44 (4), pp.819-825. 

Berman, B.M., Lao, L., Greene, M., Anderson, R.W., Wong, R.H., Langenberg, P. and Hochberg, M.C., 1995. Efficacy of traditional Chinese acupuncture in the treatment of symptomatic knee osteoarthritis: a pilot study.  Osteoarthritis and Cartilage ,  3 (2), pp.139-142.