Study
shows acupuncture helps arthritic knees
Monday, February 07,
2005
Although
it's been practiced for a couple of millennia in China, acupuncture has long been
viewed as voodoo medicine by some members of the traditional medical
establishment in the United States.
But according to a new study commissioned by the National Institutes of Health,
acupuncture provides pain relief and improves function for people with
osteoarthritis of the knee, and offers a complement to standard medical care.
That comes as no surprise to Missoula
acupuncturists, or to local physicians who have extensive experience with
patients using acupuncture to relieve pain, or to many of the patients in the
United States who have used the ancient Chinese procedure - an estimated 2.1
million adults in 2002, according to a study by the U.S. Centers for Disease
Control and Prevention.
"None of these things are a surprise to
us," said Dallas Seaber, an acupuncturist for more than eight years, who
practices at the Acupuncture Clinic of Missoula. "It's only a surprise to
those in the western medical community who have no idea what we do."
"I think
it's great that at least we've started on this track with the National
Institutes of Health," Seaber added. "It's wonderful that we're
getting some recognition. Acupuncture is in its infancy in this country. But
we've come a long ways in the last 70 years. There are probably more than 30
accredited schools in this country, and probably 12,000 to 15,000
acupuncturists practicing in this country. I think all of them are looking
forward to seeing more research done."
Acupuncture -
the practice of inserting thin needles into specific body points to improve health
and well-being - originated in China more than 2,000 years ago, according to
the National Center for Complementary and Alternative Medicine, or NCCAM, which
is part of the National Institutes of Health.
The recently
released study of the effects of acupuncture on people with arthritis of the
knee was funded by NCCAM and the National Institute of Arthritis and
Musculoskeletal and Skin Diseases, another component of the NIH.
More than 20
million Americans suffer from osteoarthritis, a degenerative and often
crippling disease of the joints, according to NIAMS.
Results of the
study could lead to more physicians and patients considering the use of
acupuncture as an alternative or complementary treatment for the pain of
arthritis, and could help convince more insurance companies to cover the
procedure, according to local physicians and acupuncturists.
Findings of
the study - the longest and largest random, controlled clinical trial of
acupuncture ever conducted - were published in the Dec. 21, 2004, issue of
Annals of Internal Medicine.
The multi-site
study team, including rheumatologists and licensed acupuncturists, enrolled 570
patients, age 50 or older, with osteoarthritis of the knee. The patients had
experienced pain in their knee the month before joining the study, but had
never had acupuncture.
Participants
were randomly assigned to receive one of three treatments: acupuncture,
"sham" acupuncture, or the control group, which followed a self-help
course for managing their condition. All patients continued to receive standard
medical care from their primary physicians, including anti-inflammatory
medications and pain relievers.
During the
course of the study, 190 patients received true acupuncture, and 191 patients
received sham acupuncture for 24 treatment sessions over 26 weeks. Sham
acupuncture involved use of fake needles that didn't penetrate the skin. The
189 patients in the control group attended six, two-hour group sessions over 12
weeks, based on the Arthritis Foundation's Arthritis Self-Help Course, which
has proved effective, according to the NIH.
When they
started the study, the patients' pain and knee function were assessed using
standard arthritis methods and instruments. Patients' progress was assessed at
four, eight, 14 and 26 weeks.
By week eight,
participants receiving acupuncture were showing a significant decrease in pain,
compared with the sham and control groups. Those results held through week 26.
Overall, the group that received acupuncture had a 40 percent decrease in pain
and a nearly 40 percent improvement in function compared to their initial
assessment.
"This
study is significant because it's the first rigorous study of acupuncture to be
conducted in the U.S.," said Paul Gourguechan, an acupuncturist at
Missoula's Blue Mountain Clinic who has practiced for more than four years.
"One of the main barriers to mainstream acceptance of acupuncture is this
dearth of scientific evidence. I think this will convince many in the
conventional medical community of its validity."
Acupuncture relieves pain "by facilitating the
flow of energy in channels of the body," Gourguechan explained. "Pain
is caused by obstruction of the flow of 21 qi (pronounced 'chee'), or the
energy in the body. Acupuncture needles have the function of removing obstructions.
In this way, it reduces or eliminates pain."
The
acupuncture procedure for relieving pain of the knee typically takes an hour
and a half for the first treatment, and an hour for subsequent treatments,
according to Gourguechan. The time that needles are actually in the body is
approximately 30 to 45 minutes. The number of needles used in the procedure
varies from patient to patient, he said, but generally requires about 15.
The recently
released NIH study on acupuncture focuses on knee pain associated with
osteoarthritis, "which is a particularly stubborn problem," said
Gourguechan. "So the study indicates a pretty good success rate. I've
treated other knee problems, say from trauma, and had excellent results."
In his
experience, he said, acupuncture also has been highly successful in treating
"at least 30" patients with knee pain specifically caused by
osteoarthritis.
"In most
cases," said Gourguechan, "I've not been able to eliminate pain
entirely. But I've been able to relieve pain enough so that they can get back
to their normal routine, and walking again."
Seaber said
he's had success treating hundreds of patients suffering from pain of arthritis
in "any joints."
"You can
find people up and down the West Coast and all over the country that do this
every day," Seaber added.
One important
outcome of the study, said Gourguechan, will be to create awareness of an
alternative to the use of pain-killing drugs, especially now that Vioxx has
been pulled from the market for safety reasons, and another drug in the same
class, Celebrex, has been linked to heart attacks and strokes.
Dr. Randale
Sechrest of Missoula, the director of the Montana Spine Center at St. Patrick
Hospital and Health Sciences Center, said the new NIH study reinforces his
experience with acupuncture.
"I think
it's probably somewhat misleading to look at it just for knee pain," said
Sechrest. "There's lots of evidence that it really does work for pain,
especially the perception of pain. We use it to reduce patients' reliance on narcotics.
We've used it for a long time."
Shirley Missil, a former Missoula patient of
Gourguechan's who now lives in Parma, Idaho, can vouch for the effectiveness of
acupuncture in relieving knee pain.
She went to
see Gourguechan after she had knee replacement surgery and developed
osteoarthritis in the joint. Missil had acupuncture treatments over a period of
about six months, she said. At first, she had the procedure twice a week, less
often later as her pain decreased.
"It was
wonderful, absolutely wonderful," she said. "I'd go in there, and I
could hardly walk. And I could walk out just fine. The pain was gone. It was
just that fast."
When she
started the acupuncture treatments, Missil said, she was taking heavy doses of
pain medication.
"At the
end," she said, "I was down to one ibuprofen. That did it."
She had her
last acupuncture treatment from Gourguechan in September, just before she moved
to Idaho from Missoula, Missil said. And she continues to be "relatively
pain-free."
Dr. Eric
Ravitz, a physician at the Blue Mountain Clinic, said he frequently recommends
acupuncture for patients suffering pain from a variety of medical problems.
"I'm kind
of a results-oriented family practitioner," said Ravitz. "Whatever
works, and does no harm, is good. I've seen excellent results from acupuncture
in a lot of areas, whether it's for muscular-skeletal conditions, for
relaxation it seems to work, and chronic neck and low-back pain.
"The
problem," he added, "is we'd have more numbers of people doing it if more
insurance companies would cover it. Sure, I do refer patients to
acupuncturists. But the big obstacle is lack of insurance coverage. I would
send more patients to acupuncturists if it were more accepted by insurance
companies."
The new NIH
study could help the practice gain more widespread acceptance by insurers,
Ravitz said.
"I think
that's what Paul (Gourguechan) is excited about," he said. "It (the
study) legitimizes the modality. That's what insurance companies are looking
for. If they see it's not just voodoo medicine, they're more likely to use it,
especially if it can be shown to be an alternative to expensive drugs.
Definitely, I think the potential is there. It's the kind of thing that could
generate more studies."
Gourguechan is
optimistic that the NIH acupuncture study will open eyes in the long-skeptical
traditional medical establishment and open doors for patients looking for
options to relieve pain of osteoarthritis.
"There's
going to be increased interest in health care modalities that have fewer side
effects," he said. "And acupuncture is right up there at the
top."
http://www.missoulian.com/articles/2005/02/08/news/local/znews01.txt