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Comparative Effectiveness Review of Acupuncture for the Treatment of Knee Osteoarthritis: Review of Reviews

July 24, 2018

Health Problem: Osteoarthritis (OA) of the knee is a common, debilitating, painful condition with few treatment options. The cartilage between the bones degenerates, no longer providing a smooth, gliding surface for motion or adequate cushioning. Damaged articular cartilage does not tend to heal and may progressively worsen and cause focal lesions, eventually leading to OA. Because OA damages the cartilage and may ultimately damage the bone, it disrupts how components work together, resulting in pain, swelling, inflammation, muscle weakness, impaired quality of life (QOL), and reduced function.

Technology Description: The technique of acupuncture involves percutaneous insertion of very fine needles to a depth of approximately 10 to 15 millimeters at prescribed acupoints. In some cases, low-voltage current is applied to the needles; this is referred to as electroacupuncture.

Controversy: Concerns regarding the opioid epidemic have fueled considerable interest in nonpharmacological strategies, including acupuncture, for pain management in recent years. Numerous federal regulatory agencies have advised or mandated that nonpharmacologic options for pain be offered by healthcare systems and providers. Acupuncture is controversial in the United States because of lack of clear mechanisms for efficacy, inconsistent findings in studies in the peer-reviewed literature, and heterogeneity in techniques and treatment administration

Key Questions:

  • Does acupuncture reduce pain associated with knee OA and improve function?
  • Is acupuncture safe for treating knee OA?
  • What is the comparative efficacy and safety of acupuncture for knee OA compared with sham acupuncture, no treatment, conventional drug treatment, and nonpharmacological treatments?
  • Have definitive patient selection criteria been established for acupuncture for the treatment of knee OA?