Dec., 2004



Article which led to the CBC TV coverage:
Acupuncture works to relieve arthritis pain: study
Last Updated Tue, 21 Dec 2004 04:32:40 EST
CBC News TORONTO - Combining acupuncture with standard drug therapy can relieve pain and improve movement in people with arthritis of the knee, according to a new study.

"For the first time, a clinical trial with sufficient rigour, size, and duration has shown that acupuncture reduces the pain and functional impairment of osteoarthritis of the knee," said Dr. Stephen Straus in a release.

The results also suggest acupuncture can help improve quality of life for people with knee osteoarthritis, added Straus, a director of the National Center for Complementary and Alternative Medicine, part of the U.S. government agency that funds medical research.
In the trial, Dr. Brian Berman of the University of Maryland School of Medicine in Baltimore and his colleagues studied 570 patients with an average age of 65 who had osteoarthritis of the knee.

Participants were randomly assigned to receive one of three treatments for 26 weeks, in addition to standard care such as anti-inflammatory medications and pain relievers:

• Acupuncture – inserting thin needles into certain body points to stimulate improved health.
• Sham acupuncture – patients feel some sensation from a needle but it isn't actually inserted.
• A self-help course for managing pain.

By week eight, patients receiving true acupuncture began showing a significant increase in function and by week 14 a significant decrease in pain, compared to those in the other groups, Berman's team reported in the Dec. 21 issue of the Annals of Internal Medicine
What sets the study apart from previous research is the extent of time the patients were followed, said Dr. Shawn Thistle, an acupuncture practitioner in Toronto.

Nevertheless, the study has its limitations. A sizeable number of patients dropped out over the 26 weeks, reducing the reliability of the results.

Also, the findings don't show acupuncture is better than other treatments or if it is more cost-effective than drugs. Since acupuncture is generally safe, researchers say the treatment deserves further study, given the recent news about the dangerous side-effects of some arthritis medications.

The use of sham acupuncture also controlled for the placebo effect, in which patients expect relief with no real treatment.

ADDITIONAL READING:
Common arthritic knee surgery no better than placebo: study
Last Updated Thu, 11 Jul 2002 10:56:42 EDT
CBC News HOUSTON, TEX. - Patients who have arthroscopic surgery for arthritis in their knees may feel better even though the surgery didn't help, a new study suggests.

A team of surgeons in Texas tested the procedure by performing the surgery on 180 patients with osteoarthritis in the knee. Two-thirds got two different types of the surgery.

But for a third, the surgeons faked it – they went through the motions of giving a tranquilizer, making three incisions and pretending to do the surgery.

All participants in the study had to sign their chart to show they understood they might receive the placebo surgery, which would not help their arthritic knee.

Most arthroscopic surgery on the knee is done to repair injured ligaments and cartilage, which doctors say is useful. The experiment was designed to see whether the surgery helped reduce pain and increase mobility in patients with an arthritic knee.

The researchers found patients who underwent the placebo surgery were just as likely to report pain relief as those who received the real procedure. It seems for osteoarthritis patients, the relief is all in patients' heads.

"I don't believe that arthroscopic surgery for osteoarthritis of the knee is any more beneficial than a placebo effect, and I don't recommend it," said Dr. Bruce Moseley, an orthopedics professor at Baylor College in Houston and one of the study's co-authors.
 
Former skier Todd Brooker of Collingwood, Ont., has had 13 knee surgeries for injuries and arthritis that developed after a fall in January 1987 that ended his skiing career.

"My doctor would go in through the scope and he would basically vacuum stuff out of there and clean up that whole area," Brooker said. He said it's hard to accept that he feels better because of the placebo effect.

Provincial health ministers will have to re-think paying for surgery.

Orthopedic surgeon Dr. John Cameron of Toronto said the study provides the ammunition he needs to convince osteoarthritis patients that the procedure doesn't work. "If it isn't doing them any good, we shouldn't be doing it," said Cameron. "That's the message of this paper."

One of the study's investigators, Dr. Nelda Wray of the Houston VA Medical Center and Baylor College, said the study makes doctors question whether money spent on the procedures could be put to better use. Provincial governments will now have to determine if the procedure is just an expensive placebo.

The study appears in Thursday July 11, 2002 issue of The New England Journal of Medicine.