FPIN's Help Desk Answers

Acupuncture for Knee Osteoarthritis


Am Fam Physician. 2020 Aug 1;102(3):184-185.

Clinical Question

Are needle-only acupuncture and electroacupuncture effective treatments for knee osteoarthritis?

Evidence-Based Answer

Electroacupuncture can be used to improve pain and physical function in adults with knee osteoarthritis. (Strength of Recommendation [SOR]: A, based on multiple meta-analyses of randomized controlled trials [RCTs].) Electroacupuncture seems to be more effective than needle acupuncture for symptoms of knee osteoarthritis, but both treatments are more effective than standard care. (SOR: B, based on network meta-analyses with inconsistent results.) Needle-only acupuncture offers pain relief and functional improvement, but not consistently at clinically relevant levels. (SOR: B, based on a meta-analysis and RCTs with inconsistent results.)

Evidence Summary

A 2010 systematic review of 16 RCTs (N = 3,498) compared needle acupuncture with a sham intervention for short- and long-term (up to eight weeks and 26 weeks, respectively) pain relief and functional improvement in patients with peripheral joint osteoarthritis.1 This meta-analysis included studies measuring outcomes in patients with knee osteoarthritis (12 trials), hip osteoarthritis (three trials), or both. The included studies measured pain and function using a variety of scales, so authors collected the average change in scores for each study using the standardized mean difference. Acupuncture produced statistically significant improvements in pain and function, but the effect was small. In a secondary analysis of acupuncture vs. wait-list controls, acupuncture produced statistically and clinically relevant improvements in patients with osteoarthritis.

A 2013 systematic review and network meta-analysis of 24 RCTs (N = 1,219) compared acupuncture with standard care (analgesics, education, or exercise advice) in adults 55 years and older with knee osteoarthritis.2 Postintervention pain was assessed using a variety of pain scales; outcomes were reported using the standardized mean difference.

Address correspondence to Susan E. Hansen, MA, at susan_e.hansen@lvhn.org. Reprints are not available from the authors.

Author disclosure: No relevant financial affiliations.

Copyright © Family Physicians Inquiries Network. Used with permission.


show all references

1. Manheimer E, Cheng K, Linde K, et al. Acupuncture for peripheral joint osteoarthritis. Cochrane Database Syst Rev. 2010;(1):CD001977....

2. Corbett MS, Rice SJ, Madurasinghe V, et al. Acupuncture and other physical treatments for the relief of pain due to osteoarthritis of the knee: network meta-analysis. Osteoarthritis Cartilage. 2013;21(9):1290–1298.

3. Li S, Xie P, Liang Z, et al. Efficacy comparison of five different acupuncture methods on pain, stiffness, and function in osteoarthritis of the knee: a network meta-analysis [published correction appears in Evid Based Complement Alternat Med. 2019;2019:3713197]. Evid Based Complement Alternat Med. 2018;2018:1638904.

4. Shim JW, Jung JY, Kim SS. Effects of electroacupuncture for knee osteoarthritis: a systematic review and meta-analysis. Evid Based Complement Alternat Med. 2016;2016:3485875.

5. Chen N, Wang J, Mucelli A, et al. Electro-acupuncture is beneficial for knee osteoarthritis: the evidence from meta-analysis of randomized controlled trials. Am J Chin Med. 2017;45(5):965–985.

6. Nelson AE, Allen KD, Golightly YM, et al. A systematic review of recommendations and guidelines for the management of osteoarthritis: the chronic osteoarthritis management initiative of the U.S. Bone and Joint Initiative. Semin Arthritis Rheum. 2014;43(6):701–712.

Clinical Inquiries provides answers to questions submitted by practicing family physicians to the Family Physicians Inquiries Network (FPIN). Members of the network select questions based on their relevance to family medicine. Answers are drawn from an approved set of evidence-based resources and undergo peer review. The strength of recommendations and the level of evidence for individual studies are rated using criteria developed by the Evidence-Based Medicine Working Group (https://www.cebm.net).

The complete database of evidence-based questions and answers is copyrighted by FPIN. If interested in submitting questions or writing answers for this series, go to https://www.fpin.org or email: questions@fpin.org.

This series is coordinated by John E. Delzell Jr., MD, MSPH, associate medical editor.

A collection of FPIN's Clinical Inquiries published in AFP is available at https://www.aafp.org/afp/fpin.



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