Acupuncture and Knee Pain

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acupuncture for knee pain

Acupuncture & Knee Pain

Mechanism of action and research

Acupuncture and Knee Pain

Slowly but surely modern approaches to acupuncture are being evaluated in a scientific manner. This is a good thing, because there is a plethora of anecdotal evidence that acupuncture is effective and a growing body of scientific evidence that patients benefit from evidence based acupuncture treatments.

Yet, there is still no shortage of folks who seem to want to cast acupuncture in a negative light to create a convenient straw man. Blog post like this basically push a narrative that all needling is useless, however this conflicts with scientific data published in reputable journals, done by researchers from reputable medical institutions:

Busse et al. (2017). Guideline for opioid therapy and chronic noncancer pain. CMAJ.

Chen et al. (2017). Management of chronic pain using complementary and integrative medicine. BMJ.

Lin et al. (2016). The Effects of Acupuncture on Chronic Knee Pain Due to Osteoarthritis: A Meta-Analysis. The Journal of Bone & Joint Surgery.

MacPherson et al. (2017). Acupuncture for chronic pain and depression in primary care: a programme of research. Southampton (UK): NIHR Journals Library.

Nahin et al. (2016). Evidence-Based Evaluation of Complementary Health Approaches for Pain Management in the United States. Mayo Clinic Proceedings.

Woods, B., Manca, A., ... Sculpher, M. (2017). Cost-effectiveness of adjunct non-pharmacological interventions for osteoarthritis of the knee. PLoS One.

Acupuncture Research Has Matured

The preponderance of evidence is that evidence based acupuncture yields short and long-term improvement in function and pain relief in patients who suffer from osteoarthritis related knee pain.

If you use Occam's razor, the insertion of an acupuncture needle is a form of novel stimuli, that functions by sending anti-nociceptive input to the neuroimmune system. 

Preferential sites for acupuncture stimulation are associated with areas rich in specialized sensory receptors such as muscle spindles, Golgi tendon organs, ligament receptors, Paciniform and Ruffini’s receptors (joint capsules), deep pressure endings (within muscle belly), and free nerve endings (muscle and fascia).

All of these areas are highly innervated and as a result there are a number of physiological changes across different areas of the peripheral and central nervous systems including: peripheral receptors, dorsal horn of the spinal cord, brainstem, sensorimotor cortical areas, and the mesolimbic and prefrontal areas (Chen et al. 2017).

But Isn't Acupuncture Just a Placebo?

For those who are unfamiliar with the literature, it may be easy to assume that acupuncture is just a placebo. It is clear that the placebo response is a big part of why patients feel better, but it is also a within the realm of reasons that patients have a complex biopsychosocial response to acupuncture that INCLUDES but is not LIMITED to placebo. 

More to Explore

Busse, J.W., Craigie, S., Juurlink, D.N, ... Guyatt GH. (2017). Guideline for opioid therapy and chronic noncancer pain. CMAJ.
https://www.ncbi.nlm.nih.gov/pubmed/28483845

Chen, L., Michalsen, A. (2017). Management of chronic pain using complementary and integrative medicine. BMJ.
https://www.ncbi.nlm.nih.gov/pubmed/28438745

Corbett, M.S., Rice, S.J., Madurasinghe, V., ... Woolacott, N.F. (2013). Acupuncture and other physical treatments for the relief of pain due to osteoarthritis of the knee: network meta-analysis. Osteoarthritis Cartilage.
https://www.ncbi.nlm.nih.gov/pubmed/23973143

Elbadawy, M. A. (2016). Effectiveness of Periosteal Stimulation Therapy and Home Exercise Program in the Rehabilitation of Patients with Advanced Knee Osteoarthritis. The Clinical Journal of Pain.
http://www.ncbi.nlm.nih.gov/pubmed/27513639

Ji, R.R., Chamessian, A., Zhang, Y.Q. (2016). Pain regulation by non-neuronal cells and inflammation. Science.
https://www.ncbi.nlm.nih.gov/pubmed/27811267

Kirkley, A., Birmingham, T.B., Litchfield, R.B., ... Fowler, P.J. (2008). A randomized trial of arthroscopic surgery for osteoarthritis of the knee. N Engl J Med.
https://www.ncbi.nlm.nih.gov/pubmed/18784099

Lin, X., Huang, K., Zhu, G., Huang, Z., Qin, A., & Fan, S. (2016). The Effects of Acupuncture on Chronic Knee Pain Due to Osteoarthritis: A Meta-Analysis. The Journal of Bone & Joint Surgery.
https://www.ncbi.nlm.nih.gov/pubmed/27655986

MacPherson, H., Vickers, A., Bland, M., Torgerson, D., Corbett, M., Spackman, E., ..., Watt, I. (2017). Acupuncture for chronic pain and depression in primary care: a programme of research. Southampton (UK): NIHR Journals Library.
https://www.ncbi.nlm.nih.gov/pubmed/28121095

Murakami, M., Fox, L., Dijkers, M.P. (2017). Ear Acupuncture for Immediate Pain Relief-A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Pain Med.
https://www.ncbi.nlm.nih.gov/pubmed/28395101

Nahin, R. L., Boineau, R., Khalsa, P. S., Stussman, B. J., & Weber, W. J. (2016). Evidence-Based Evaluation of Complementary Health Approaches for Pain Management in the United States. Mayo Clinic Proceedings.
http://www.ncbi.nlm.nih.gov/pubmed/27594189

Pavlov, V.A., Tracey, K.J. (2017). Neural regulation of immunity: molecular mechanisms and clinical translation. Nat Neurosci.
https://www.ncbi.nlm.nih.gov/pubmed/28092663

Rane, L., Bull, A.M. (2016). Functional electrical stimulation of gluteus medius reduces the medial joint reaction force of the knee during level walking. Arthritis Res Ther.
https://www.ncbi.nlm.nih.gov/pubmed/27809923

Salazar, T.E., Richardson, M.R., Beli, E., ... Grant, M.B. (2017). Electroacupuncture Promotes CNS-Dependent Release of Mesenchymal Stem Cells. Stem Cells.
https://www.ncbi.nlm.nih.gov/pubmed/28299842

Sawynok, J. (2016). Adenosine receptor targets for pain. Neuroscience.
https://www.ncbi.nlm.nih.gov/pubmed/26500181

Siemieniuk, R.A.C., Harris, I.A., Agoritsas, T., ... Kristiansen, A. (2017). Arthroscopic surgery for degenerative knee arthritis and meniscal tears: a clinical practice guideline. BMJ.
https://www.ncbi.nlm.nih.gov/pubmed/28490431

Suarez-Almazor, M. E., Looney, C., Liu, Y., Cox, V., Pietz, K., Marcus, D. M., & Street, R. L. (2010). A randomized controlled trial of acupuncture for osteoarthritis of the knee: Effects of patient-provider communication. Arthritis Care Res Arthritis Care & Research.
http://www.ncbi.nlm.nih.gov/pubmed/20506122

Tang, Y., Yin, H., Rubini, P., & Illes, P. (2016). Acupuncture-Induced Analgesia: A Neurobiological Basis in Purinergic Signaling. The Neuroscientist.
http://www.ncbi.nlm.nih.gov/pubmed/27343858

Vickers, A. J., Cronin, A. M., Maschino, A. C., Lewith, G., Macpherson, H., Foster, N. E., . . . Collaboration, F. T. (2012). Acupuncture for Chronic Pain. Archives of Internal Medicine.
https://www.ncbi.nlm.nih.gov/pubmed/22965186

Witt, C., Brinkhaus, B., Jena, S., Linde, K., Streng, A., Wagenpfeil, S., . . . Willich, S. (2005). Acupuncture in patients with osteoarthritis of the knee: A randomised trial. The Lancet.
http://www.ncbi.nlm.nih.gov/pubmed/16005336

Woods, B., Manca, A., ... Sculpher, M. (2017). Cost-effectiveness of adjunct non-pharmacological interventions for osteoarthritis of the knee. PLoS One.
https://www.ncbi.nlm.nih.gov/pubmed/28267751 

Yuan, Q., Wang, P., Liu, L., Sun, F., Cai, Y., Wu, W., . . . Zhang, Y. (2016). Acupuncture for musculoskeletal pain: A meta-analysis and meta-regression of sham-controlled randomized clinical trials. Scientific Reports.
https://www.ncbi.nlm.nih.gov/pubmed/27471137

Zhang, R., Lao, L., Ren, K., & Berman, B. M. (2014). Mechanisms of Acupuncture–Electroacupuncture on Persistent Pain. Anesthesiology. 
https://www.ncbi.nlm.nih.gov/pubmed/24322588 (OPEN ACCESS)