Acupuncture as a complementary therapy to the pharmacological treatment of osteoarthritis of the knee: randomised controlled trial

doi:10.1136/bmj.38238.601447.3A

BMJ 2004;329:1216 (20 November), doi:10.1136/bmj.38238.601447.3A (published 19 October 2004)

Primary care

Acupuncture as a complementary therapy to the pharmacological treatment of osteoarthritis of the knee: randomised controlled trial

Jorge Vas, chief medical officer¹, Camila Méndez, epidemiologist², Emilio Perea-Milla, chief medical officer³, Evelia Vega, chief medical officer⁷, María Dolores Panadero, pharmacologist², José María León, professor⁴, Miguel Ángel Borge, chief medical officer⁶, Olga Gaspar, nurse¹, Francisco Sánchez-Rodríguez, technician⁵, Inmaculada Aguilar, nurse¹, Rosario Jurado, nurse¹

¹ Pain Treatment Unit, Centro de Salud "Dos Hermanas A" (Distrito Sanitario Sevilla-Sur), 41700 Dos Hermanas, Spain, ² Distrito Sanitario Sevilla-Sur, Alcalá de Guadaira 41500, Spain, ³ Research Support Unit, Hospital Costa del Sol, 29600 Marbella, Spain, ⁴ Department of Social Psychology, Universidad de Sevilla, 41018 Sevilla, Spain, ⁵ Servicio Andaluz de Salud, Servicio de Ordenación Sanitaria, 41001 Sevilla, Spain, ⁶ Municipal Medical Services, 41927 Mairena del Aljarafe, Spain, ⁷ Pain Treatment Unit, Centro de Salud "Castilleja de la Cuesta," 41950 Castilleja de la Cuesta, Spain

Correspondence to: J Vas jvas{at}acmas.com

Objectives To analyse the efficacy of acupuncture as a complementarytherapy to the pharmacological treatment of osteoarthritis ofthe knee, with respect to pain relief, reduction of stiffness,and increased physical function during treatment; modificationsin the consumption of diclofenac during treatment; and changesin the patient's quality of life.

Design Randomised, controlled, single blind trial, with blindedevaluation and statistical analysis of results.

Setting Pain management unit in a public primary care centrein southern Spain, over a period of two years.

Participants 97 outpatients presenting with osteoarthritis ofthe knee.

Interventions Patients were randomly separated into two groups,one receiving acupuncture plus diclofenac (n = 48) and the otherplacebo acupuncture plus diclofenac (n = 49).

Main outcome measures The clinical variables examined includedintensity of pain as measured by a visual analogue scale; pain,stiffness, and physical function subscales of the Western Ontarioand McMaster Universities (WOMAC) osteoarthritis index; dosageof diclofenac taken during treatment; and the profile of qualityof life in the chronically ill (PQLC) instrument, evaluatedbefore and after the treatment programme.

Results 88 patients completed the trial. In the intention totreat analysis, the WOMAC index presented a greater reductionin the intervention group than in the control group (mean difference23.9, 95% confidence interval 15.0 to 32.8) The reduction wasgreater in the subscale of functional activity. The same resultwas observed in the pain visual analogue scale, with a reductionof 26.6 (18.5 to 34.8). The PQLC results indicate that acupuncturetreatment produces significant changes in physical capability(P = 0.021) and psychological functioning (P = 0.046). Threepatients reported bruising after the acupuncture sessions.

Conclusions Acupuncture plus diclofenac is more effective thanplacebo acupuncture plus diclofenac for the symptomatic treatmentof osteoarthritis of the knee.

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Rapid Responses:

Read all Rapid Responses

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bmj.com, 9 Nov 2004 [Full text]
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Re: Re: On the need to place the needles with conviction: John P Heptonstall
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Re: Re: Is the positive effect coming from acupuncture or segmental electrical stimulation?: Jorge Vas
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Re: Acupunture for OA of the knee. Vas J et al BMJ 2004; 329;1216-9: Jorge Vas
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