The effect of acupuncture on patients with knee pain
This week, I came across a new study published in The Clinical Journal of Pain, this study looks at the effect of acupuncture on patients with osteoarthritis, reading through the study I was impressed because the treatment approach is similar to the neurofunctional approach taught by Alejandro Elorriaga and Mike Prebeg. 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 the most negative possible light to create a convenient straw man. The suggestion that all needling is useless conflicts with scientific data published in reputable journals, done by researchers from reputable medical institutions:
• A 2016 meta-analysis, published in The Journal of Bone & Joint Surgery
• A 2016 meta-analysis, published by the Nature Publishing Group
• A 2016 review, published by the Mayo Clinical Proceedings
• A 2013 meta-analysis, published in Osteoarthritis and Cartilage
• A 2012 meta-analysis, published in JAMA Internal Medicine
• A 2012 randomized control trial, published in Pain
• A 2010 systematic review, published by The Cochrane Collaboration
• A 2007 meta-analysiss published in Annals of Internal Medicine
• A 2007 systematic review, published in Rheumatology
• A 2006 meta-analysis, published in Rheumatology
• A 2006 randomized control trial, published in Arthritis & Rheumatology
• A 2006 randomized control trial, published in Annals of Internal Medicine
• A 2005 randomized control trial, published in The Lancet
• A 2004 randomized control trial, published in Annals of Internal Medicine
Wired up ... And fired up
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. It is my impression that many still remain skeptical of acupuncture research, because they believe that there is "no way there are energy meridians that run through the body". Well the beauty of the neurofunctional approach is that it does not require a knowledge of meridians or qi, it requires a deep understanding of the physiological responses to needling.
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.
Scientists have been studying potential biological pathways by which needling might relieve pain, most of the research in the past have focused on endogenous opioids. Another proposed mechanism of action is a localized adenosine response. It has been demonstrated that acupuncture needles trigger a release of adenosine from the surrounding cells into the extracellular fluid, this chemical release works to ease pain by reducing inflammation. This is just the tip of the iceberg, I do plan on going into more depth in an upcoming post. In the meantime if you would like to learn more about the physiology involved I recommend this introductory YouTube video from Thomas Lundeberg (23 min in length).