Acupuncture arthritis knee ankle pain
by Nathan Wei, MD, FACP, FACR
Nathan Wei is a nationally known board-certified rheumatologist and author of the Second Opinion Arthritis Treatment Kit. It's available exclusively at this website... not available in stores.
Click here: Second Opinion Arthritis Treatment Kit
Acupuncture is the "science or skill... depending on how you look at it" of inserting fine needles into the skin at precise special points in order to achieve a desired result. It originated in China thousands of years ago, and is based on the theory that an essential life energy called qi (pronounced chee) flows through the body along invisible channels, called meridians. When the flow of qi is blocked or out of balance, illness or pain results. According to Chinese theory, stimulation of specific points along the meridians can correct the flow of qi to restore or optimize health, or to block pain.
Methods for administering acupuncture include:
Electro-acupuncture: The most commonly used technique is the insertion of needles connected to an electrical source. The insertion of each needle is usually not that painful. After cleansing the skin, the needles are inserted into selected acupuncture points along carefully defined "meridians". After all the needles are in place, a small direct current usually supplied by a 9-volt battery from a small stimulator is delivered to the needles by using alligator clips clipped to the needles. The patient usually feels muscle twitching as the muscles are stimulated. Some patients may feel sensations such as warmth at the site of stimulation. After about 5 - 20 minutes of stimulation, the session is completed.
Manual Acupuncture: This employs the same needle insertion technique as above.Instead of electrical stimulation, each needle is manually manipulated by "twirling".
Auricular Acupuncture is the insertion of needles into the earlobes and uses the above methods of stimulation. There are approximately 168 acupuncture points on a human ear!
Other methods of acupuncture include scalp-needling in which acupuncture needles are inserted into acupuncture points on the scalp. Face and hand acupuncturists use acupuncture points on the meridians on the face and hand, respectively.
Alternative means of delivering stimulation to acupuncture points include moxibustion - a rolled up clump of herbs is attached to the top of the acupuncture needle and then is lit to deliver heat to the needle and to the patient.
Cupping is the application of heated cups to create a suction effect on the skin.
Bloodletting is a technique of using a sharp lancet or needle to cause a small amount of bleeding.
Laser - generally what is called "cold laser" has been used to stimulate the acupuncture points on the skin.
Another variation is the use of magnets, staples or metal pellets which are attached to various acupuncture points.
Acu-pressure is a technique requiring the use of manual manipulation of acupuncture points.
A "modern" type of electrical acupuncture is a device called a TENS (Transcutaneous Electrical Nerve Stimulator)machine. This device, which is about the size of a pack of cigarettes is connected via wires and sticky electrodes to various acupuncture points in order to alleviate pain. This can be every effective for some patients with arthritis.
Why acupuncture works is still controversial. Admittedly, there are still some who question whether there is an effect above and beyond placebo.
However, some acupoints correspond to areas called tender points, which have been clearly defined in fibromyalgia patients in the arthritis literature.
The stimulation of acupoints has been shown in some studies to cause a release of chemicals in the muscles, spinal cord and brain that leads to the release of natural hormonal factors that can relieve pain such as endorphins and enceflins.
Among the many studies that show it can relieve osteoarthritis symptoms is one Scandinavian study where 25 percent of patients previously scheduled for knee surgery canceled the operation. That same study showed booster treatments once a month caused sustained the pain relief.
Other studies have shown that acupuncture helps relieve the pain of fibromyalgia and osteoarthritis; can decrease the number and severity of Raynaud's phenomenon attacks; helps ease conditions that can accompany arthritis such as depression and irritable bowel syndrome; and enhance conventional treatments for various arthritides. That is why the term "complementary" is preferable to the use of the term "alternative" when describing acupuncture as a medical treatment.
The downside is this...many studies are not published in English and few acupuncture studies meet rigorous scientific standards. There's enough research to suggest acupuncture relieves pain for some, and that it is safe when performed by a trained professional using sterile or disposable needles.
Acupuncture appears to work best on fibromyalgia and soft-tissue pain, and to be least effective for rheumatoid arthritis or other systemic inflammatory conditions.
In a study published in the Lancet recently, researchers tested the effects of acupuncture on nearly 300 patients with osteoarthritis of the knee, the joint most often affected by the disease.
"Acupuncture treatment had significant and clinically relevant short-term effects," said lead researcher Dr Claudia Witt, deputy administrative director of the Institute of Social Medicine, Epidemiology, and Health Economics at the Charite University Medical Centre in Berlin, Germany.
For the study, 294 patients with chronic osteoarthritis of the knee were randomly selected to receive either acupuncture or simulated acupuncture, while another group was put on a waiting list. This latter group was used as a "control" group so the researchers could accurately measure the effect of the therapy.
Patients were given acupuncture in 12 sessions over eight weeks. Witt's group followed the patients for one year after treatment. "Patients with osteoarthritis of the knee who received acupuncture had significantly less pain and better function after eight weeks than patients who received minimal acupuncture or no acupuncture," Witt said.
"However, after 26 and 52 weeks, exploratory analysis indicated that the differences between acupuncture and minimal acupuncture were no longer significant," she added.
Based on these findings, Witt believes that acupuncture could be an effective alternative to other treatments for osteoarthritis. "Patients who suffer from chronic pain due to osteoarthritis of the knee could try acupuncture treatment to reduce pain and stiffness and improve physical function," she advised.
Another study, funded by the National Institutes of Health also showed the promise of acupuncture in arthritis. 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.
While no specific study looking specifically at ankle arthritis has been published, the findings for knee arthritis seem to be applicable.
One fact experts concur on is that acupuncture won't cure arthritis. Acupuncture is generally safe, but as with any therapy – conventional or alternative – there are precautions.
Here are some recommendations from the National Institutes of Health:
• Choose a therapist who is licensed and/or a graduate of a respected school of acupuncture, and who is willing to work with your doctor. Some 10,000 acupuncturists currently practice in the United States and most are regulated by the state in which they reside. About 4,000 doctors have completed a recognized acupuncture training program
• Get a diagnosis from a medical doctor before undergoing acupuncture, to make sure you don't have a condition requiring prompt medical attention.
• Don't stop your medications without consulting your doctor. Acupuncture works with, not instead of, conventional medicine.
• Tell the acupuncturist about all health conditions, including pregnancy; and list all medications (including herbs and non-steroidal anti-inflammatory drugs that could cause you to bleed, for example).
• Be sure the acupuncturist uses sterilized or disposable needles.
• Don't take muscle relaxants, tranquilizers or painkillers right before acupuncture, as acupuncture may intensify the effects of these drugs.
• Tell the practitioner right away if you experience pain or bleeding. Acupuncture shouldn't hurt after the initial sting of the needle's insertion; you should not bleed more than a few drops.
• Don't automatically take herbs offered by traditional Chinese practitioners. They could interact with prescription drugs.
• Keep notes about your response to the treatment, and tell your doctor and acupuncturist about any changes.
• Track your progress. If you have no response at all after four to six sessions, this therapy may not work for you. Or you may want to try another therapist, because, as in any therapy, skill levels vary.
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