Are acupuncture and laser acupuncture effective in treating chronic knee pain?
Date of publication of the randomized controlled trial: October 2014
Design
Randomized controlled trial (RCT).
Participants
282 participants aged 50 years or older who had knee pain of longer than 3 months’ duration and most days with average severity of 4 or more out of 10 on a numeric rating scale (NRS).
Intervention
A combined Western and traditional Chinese medicine style of acupuncture was provided for 12 weeks. Twenty-minute treatments were delivered once or twice weekly, with 8 to 12 sessions in total. Acupuncturists treated according to usual practice using a standardized set of acupuncture points, selecting from points around the knee as well as distal points.
Comparator
Comparison 1: Needle acupuncture versus no acupuncture;
Comparison 2: Laser acupuncture versus no acupuncture.
Major Outcomes
Outcome 1: Average knee pain as measured by an 11-point NRS with terminal descriptors of ‘no pain’ and ‘worst pain possible’, with higher scores indicating worse knee pain at week 12;
Outcome 2: Physical function as measured by Western and McMaster Universities Osteoarthritis Index (WOMAC) function subscale, with higher scores indicating worse function at week 12.
Settings
This study was performed in an outpatient setting.
Comparison    Needle acupuncture versus no acupuncture
Main Results
Compared to no acupuncture, needle acupuncture resulted in modest improvements in average knee pain as measured by NRS (mean difference (MD): -1.1, 95% CI: -1.8 to -0.4). Compared to no acupuncture, needle acupuncture also resulted in modest improvement in patients’ physical function as measured by WOMAC (MD: -3.9, 95% CI: -7.7 to -0.2).
Comparison 1: Needle acupuncture versus no acupuncture among chronic knee pain patients at week 12
Outcomes (units) No. of studies (Total no. of participants) Mean score (SD) / No. of participants Heterogeneity test (I2) MD (95% CI) p value Overall quality of evidence*
Intervention Comparator
1 (NA) 1(133) Not reported/ 64 Not reported / 69 Not applicable as there is only 1 study -1.1 (-1.8 to -0.4) 0.002 Moderate
2 (NA) 1(133) Not reported/ 64 Not reported / 69 Not applicable as there is only 1 study -3.9 (-7.7 to -0.2) 0.04 Moderate
Keys: MD = mean difference, CI = confidence interval, SD = standard deviation
Comparison    Laser acupuncture versus no acupuncture
Main Results
Compared to no acupuncture, laser acupuncture showed significant improvement in average knee pain as measured by NRS (MD: -0.8, 95% CI: -1.5 to 0.1). However, it did not show significant improvement in physical function as measured by WOMAC (MD: -1.7, 95% CI: -5.1 to 1.8).
Comparison 2: Laser acupuncture versus no acupuncture among chronic knee pain patients at week 12
Outcomes (units) No. of studies (Total no. of participants) Mean score (SD) / No. of participants Heterogeneity test (I2) MD (95% CI) p value Overall quality of evidence*
Intervention Comparator
1 (NA) 1 (134) Not reported/ 65 Not reported/ 69 Not applicable as there is only 1 study -0.8 (-1.5 to 0.1) 0.03 Low
2 (NA) 1 (134) Not reported/ 65 Not reported/ 69 Not applicable as there is only 1 study -1.7 (-5.1 to 1.8) 0.34 Low
Keys: MD = mean difference, CI = confidence interval.
Comparison    Needle acupuncture versus no acupuncture
Main Results
Compared to no acupuncture, needle acupuncture resulted in modest improvements in average knee pain as measured by NRS (mean difference (MD): -1.1, 95% CI: -1.8 to -0.4). Compared to no acupuncture, needle acupuncture also resulted in modest improvement in patients’ physical function as measured by WOMAC (MD: -3.9, 95% CI: -7.7 to -0.2).
Comparison 1: Needle acupuncture versus no acupuncture among chronic knee pain patients at week 12
Outcomes (units) 1 (NA) 2 (NA)
No. of studies (Total no. of participants) 1(133) 1(133)
Mean score (SD) / No. of participants Intervention Not reported/ 64 Not reported/ 64
Comparator Not reported / 69 Not reported / 69
MD (95% CI) -1.1 (-1.8 to -0.4) -3.9 (-7.7 to -0.2)
p value 0.002 0.04
Overall quality of evidence* Moderate Moderate
Keys: MD = mean difference, CI = confidence interval, SD = standard deviation
Comparison    Laser acupuncture versus no acupuncture
Main Results
Compared to no acupuncture, laser acupuncture showed significant improvement in average knee pain as measured by NRS (MD: -0.8, 95% CI: -1.5 to 0.1). However, it did not show significant improvement in physical function as measured by WOMAC (MD: -1.7, 95% CI: -5.1 to 1.8).
Comparison 2: Laser acupuncture versus no acupuncture among chronic knee pain patients at week 12
Outcomes (units) 1 (NA) 2 (NA)
No. of studies (Total no. of participants) 1 (134) 1 (134)
Mean score (SD) / No. of participants Intervention Not reported/ 65 Not reported/ 65
Comparator Not reported/ 69 Not reported/ 69
MD (95% CI) -0.8 (-1.5 to 0.1) -1.7 (-5.1 to 1.8)
p value 0.03 0.34
Overall quality of evidence* Low Low
Keys: MD = mean difference, CI = confidence interval.
Conclusion
Benefits
Compared to no acupuncture, needle acupuncture resulted in significant improvements in average knee pain as measured by NRS and patients’ physical function as measured by WOMAC. For outcomes in this comparison, the overall quality of evidence is moderate. Further research is fairly likely to have an important impact on our confidence in this estimate of effect. Compared to no acupuncture, laser acupuncture resulted in significant improvement in average knee pain as measured by NRS but it did not provide significant benefit in patients’ physical function as measured by WOMAC. For outcomes in this comparison, the overall quality of evidence is low. Further research is likely to have an important impact on our confidence in this estimate of effect.
Harms
No adverse events were reported in this trial.
Link to Original Article
https://www.ncbi.nlm.nih.gov/pubmed/25268438
The synopsis is based on the following article:
Hinman RS, McCrory P, Pirotta M, Relf I, Forbes A, Crossley KM, et al. Acupuncture for chronic knee pain: a randomized clinical trial. JAMA. 2014 Oct 1;312(13):1313-22.


* Interpretation of quality assessment results:
• Very low: Further research is most likely to have an important impact on our confidence in this estimate of effect.
• Low: Further research is likely to have an important impact on our confidence in this estimate of effect.
• Moderate: Further research is fairly likely to have an important impact on our confidence in this estimate of effect.
• High: Further research is unlikely to have an important impact on our confidence in this estimate of effect.
• Very high: Further research is most unlikely to have an important impact on our confidence in this estimate of effect.

Details of assessment method can be found at Chung VC, Wu XY, Ziea ET, Ng BF, Wong SY, Wu JC. Assessing internal validity of clinical evidence on effectiveness of CHinese and integrative medicine: Proposed framework for a CHinese and Integrative Medicine Evidence RAting System (CHIMERAS). European Journal of Integrative Medicine. 2015 Aug 31;7(4):332-41.