Effects of acupuncture at acupoints with lower versus higher pain threshold for knee osteoarthritis: a multicenter randomized controlled trial

Abstract

Background The acupoint selections impact the effects of acupuncture, and preliminary evidence showed potential connection between pain threshold (PT) and acupuncture response. This study examined whether acupuncture at acupoints with lower PT versus higher PT would yield different effects in patients with knee osteoarthritis (KOA). Methods In this multicenter randomized clinical trial, patients were randomly assigned (1:1:1) to receive acupuncture at acupoints with lower PT (LPT group), acupuncture at acupoints with higher PT (HPT group), and no acupuncture (waiting-list group). PT was measured with electronic von Frey detector. The primary outcome was the change in WOMAC total score from baseline to 16 weeks, and the secondary outcomes were SF-12 score, and active knee range of motion (ROM). Intention-to-treat analysis was conducted with linear mixed-effect model. Results Among 666 randomized patients, 625 (93.84%) completed the study. From baseline to 16 weeks, patients in the LPT group versus HPT group had similar effects in reducing WOMAC total score (adjusted mean difference (MD) 2.21, 95% confidence interval (CI) −2.51 to 6.92, P = 0.36), while a greater reduction in WOMAC total score was observed in LPT group (−9.77, 95% CI −14.47 to −5.07, P < 0.001) and HPT group (−11.97, 95% CI −16.71 to −7.24, P < 0.001) compared with waiting-list group. There were no differences in SF-12 score and knee ROM between LPT versus HPT groups. Conclusion Our findings found that the effects of acupuncture at acupoints with lower versus higher PT were similar, both were effective for patients with KOA. Trial registration: ClinicalTrials.gov identifier: NCT03299439. Registered 3 October 2017, https://clinicaltrials.gov/ct2/show/NCT03299439

Tuina on knee pain and physical function for patients with mild-moderate knee osteoarthritis in Shanghai: protocol for a multicenter, assessor-blinded, randomized controlled trial

“…These points in TCM theory are interpreted as tonifying Qi and Blood, promoting the circulation of meridian channels and collaterals, leading to facilitating joint function recovery. Previous RCTs have also con rmed that acupoint stimulation around the knee joint has a signi cant effect on KOA and improves patients' pressure-pain threshold [53,55], which was consistent with the ndings of our previous study [39]. This multicenter pilot study expands patient recruitment beyond a single hospital setting to minimize regional differences that may exist.…”

“…The selection of press-points of Tuina treatment are mainly proximal acupoints in previous studies [53]. We referred to the results of data mining and selected the acupoints including Liangqiu (ST34), Neixiyan (EX-LE4), Dubi (ST35), and Xuehai(SP10) on the front of the thigh and Weizhong (BL40) on the back side which appeared at a high frequency in the treatment of KOA [54].…”

Acupotomy combined with intra-articular injection of sodium hyaluronate in the treatment of knee osteoarthritis

“…Studies have reported that alternative treatments, such as acupuncture, moxibustion, and acupotomy, benefit patients with KOA. [19–24]…”

Acupuncture for treatment of knee osteoarthritis: A clinical practice guideline

“…compared with no treatment. 34 An RCT published in 2021 found that electroacupuncture was more effective than manual acupuncture in improving pain, stiffness, and disfunction at the end of 8-week treatment. 35 These two RCTs might change the clinical practice of acupuncture for KOA.…”

“…A recently published large sample randomized controlled trial (RCT) found that 4‐week manual acupuncture improved the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) total score and pain, stiffness, and function subgroup scores in weeks 4 and 16 compared with no treatment 34 . An RCT published in 2021 found that electroacupuncture was more effective than manual acupuncture in improving pain, stiffness, and disfunction at the end of 8‐week treatment 35 .…”