Study shows acupuncture helps arthritic knees
By DARYL GADBOW of the Missoulian

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."