Effects of acupuncture at acupoints with lower versus higher pain threshold for knee osteoarthritis: a multicenter randomized controlled trial

Jiali Liu, Ying Li, Ling Li, Xiaochao Luo, Ning Li, Xuguang Yang, Hongxing Zhang, Zhibin Liu, Deying Kang, Yanan Luo, Yanmei Liu, Yulong Jia, Yan Ren, Minghong Yao, Yuning Wang, Jin Chen, Mewujia Maiji, Kang Zou, Ling Zhao, Fanrong Liang, Xin Sun, Jiali Liu, Ying Li, Ling Li, Xiaochao Luo, Ning Li, Xuguang Yang, Hongxing Zhang, Zhibin Liu, Deying Kang, Yanan Luo, Yanmei Liu, Yulong Jia, Yan Ren, Minghong Yao, Yuning Wang, Jin Chen, Mewujia Maiji, Kang Zou, Ling Zhao, Fanrong Liang, Xin Sun

Abstract

Background: The acupoint selections impact the effects of acupuncture, and preliminary evidence showed potential connection between pain threshold (PT) and acupuncture response. This study examined whether acupuncture at acupoints with lower PT versus higher PT would yield different effects in patients with knee osteoarthritis (KOA).

Methods: In this multicenter randomized clinical trial, patients were randomly assigned (1:1:1) to receive acupuncture at acupoints with lower PT (LPT group), acupuncture at acupoints with higher PT (HPT group), and no acupuncture (waiting-list group). PT was measured with electronic von Frey detector. The primary outcome was the change in WOMAC total score from baseline to 16 weeks, and the secondary outcomes were SF-12 score, and active knee range of motion (ROM). Intention-to-treat analysis was conducted with linear mixed-effect model.

Results: Among 666 randomized patients, 625 (93.84%) completed the study. From baseline to 16 weeks, patients in the LPT group versus HPT group had similar effects in reducing WOMAC total score (adjusted mean difference (MD) 2.21, 95% confidence interval (CI) -2.51 to 6.92, P = 0.36), while a greater reduction in WOMAC total score was observed in LPT group (-9.77, 95% CI -14.47 to -5.07, P < 0.001) and HPT group (-11.97, 95% CI -16.71 to -7.24, P < 0.001) compared with waiting-list group. There were no differences in SF-12 score and knee ROM between LPT versus HPT groups.

Conclusion: Our findings found that the effects of acupuncture at acupoints with lower versus higher PT were similar, both were effective for patients with KOA.

Trial registration: ClinicalTrials.gov identifier: NCT03299439. Registered 3 October 2017, https://ichgcp.net/clinical-trials-registry/NCT03299439.

Conflict of interest statement

All authors declare that they have no conflicts of interest: no support from any organization for the submitted work; no financial relationships with any organizations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work.

© 2022. The Author(s).

Figures

Fig. 1
Fig. 1
Study participant flow diagram
Fig. 2
Fig. 2
WOMAC total score over time during the study

References

    1. GBD Disease and Injury Incidence and Prevalence Collaborators. Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet. 2018;392(10159):1789–1858. doi: 10.1016/S0140-6736(18)32279-7.
    1. Cieza A, Causey K, Kamenov K, Hanson SW, Chatterji S, Vos T. Global estimates of the need for rehabilitation based on the global burden of disease study 2019: a systematic analysis for the global burden of disease study 2019. Lancet. 2021;396(10267):2006–2017. doi: 10.1016/S0140-6736(20)32340-0.
    1. Hunter DJ, Schofield D, Callander E. The individual and socioeconomic impact of osteoarthritis. Nat Rev Rheumatol. 2014;10(7):437–441. doi: 10.1038/nrrheum.2014.44.
    1. Bennell KL, Hunter DJ, Hinman RS. Management of osteoarthritis of the knee. BMJ. 2012;345:e4934. doi: 10.1136/bmj.e4934.
    1. Bannuru RR, Osani MC, Vaysbrot EE, Arden NK, Bennell K, Bierma-Zeinstra SMA, et al. OARSI guidelines for the non-surgical management of knee, hip, and polyarticular osteoarthritis. Osteoarthr Cartil. 2019;27(11):1578–1589. doi: 10.1016/j.joca.2019.06.011.
    1. Kolasinski SL, Neogi T, Hochberg MC, Oatis C, Guyatt G, Block J, et al. 2019 American college of rheumatology/arthritis foundation guideline for the management of osteoarthritis of the hand, hip, and knee. Arthritis Care Res. 2020;72(2):149–162. doi: 10.1002/acr.24131.
    1. Skou ST, Roos E. Cost-effectiveness of total knee replacement in addition to non-surgical treatment: a 2-year outcome from a randomised trial in secondary care in Denmark. BMJ Open. 2020;10(1):e033495. doi: 10.1136/bmjopen-2019-033495.
    1. Ferket BS, Feldman Z, Zhou J, Oei EH, Bierma-Zeinstra SM, Mazumdar M. Impact of total knee replacement practice: cost effectiveness analysis of data from the Osteoarthritis Initiative. BMJ. 2017;356:j1131. doi: 10.1136/bmj.j1131.
    1. Zhang W, Nuki G, Moskowitz RW, Abramson S, Altman RD, Arden NK, et al. OARSI recommendations for the management of hip and knee osteoarthritis: part III: changes in evidence following systematic cumulative update of research published through January 2009. Osteoarthr Cart. 2010;18(4):476–499. doi: 10.1016/j.joca.2010.01.013.
    1. Thomas KJ, Nicholl JP, Fall M. Access to complementary medicine via general practice. Br J Gen Pract. 2001;51(462):25–30.
    1. Barnes PM, Bloom B, Nahin RL. Complementary and alternative medicine use among adults and children: United States, 2007. Natl Health Stat Report. 2008;12:1–23.
    1. Nahin RL, Boineau R, Khalsa PS, Stussman BJ, Weber WJ. Evidence-based evaluation of complementary health approaches for pain management in the United States. Mayo Clin Proc. 2016;91(9):1292–1306. doi: 10.1016/j.mayocp.2016.06.007.
    1. Witt C, Brinkhaus B, Jena S, Linde K, Streng A, Wagenpfeil S, et al. Acupuncture in patients with osteoarthritis of the knee: a randomised trial. Lancet. 2005;366(9480):136–143. doi: 10.1016/S0140-6736(05)66871-7.
    1. Corbett MS, Rice SJ, Madurasinghe V, Slack R, Fayter DA, Harden M, et al. Acupuncture and other physical treatments for the relief of pain due to osteoarthritis of the knee: network meta-analysis. Osteoarthr Cartil. 2013;21(9):1290–1298. doi: 10.1016/j.joca.2013.05.007.
    1. Cao L, Zhang XL, Gao YS, Jiang Y. Needle acupuncture for osteoarthritis of the knee. A systematic review and updated meta-analysis. Saudi Med J. 2012;33(5):526–532.
    1. Yu B, Sun M, Wang Z, Zhu B, Xue J, Yang W, et al. Effects of stimulating local and distal acupoints on diabetic gastroparesis: a new insight in revealing acupuncture therapeutics. Am J Chin Med. 2021;49(5):1151–1164. doi: 10.1142/S0192415X21500555.
    1. Zhang SQ, Li JC. An introduction to traditional Chinese medicine, including acupuncture. Anat Rec (Hoboken) 2021;304(11):2359–2364. doi: 10.1002/ar.24782.
    1. MacPherson H, Thorpe L, Thomas K, Campbell M. Acupuncture for low back pain: traditional diagnosis and treatment of 148 patients in a clinical trial. Complement Ther Med. 2004;12(1):38–44. doi: 10.1016/S0965-2299(03)00125-0.
    1. Liu W, Qdaisat A, Lopez G, Narayanan S. Association between acupoint selection, target symptoms, and traditional chinese medicine diagnosis in real-time clinical practice in a comprehensive cancer center. Integr Cancer Ther. 2020;19:1534735420928490.
    1. Hogeboom CJ, Sherman KJ, Cherkin DC. Variation in diagnosis and treatment of chronic low back pain by traditional Chinese medicine acupuncturists. Complement Ther Med. 2001;9(3):154–166. doi: 10.1054/ctim.2001.0457.
    1. Ohrbach R, Gale EN. Pressure pain thresholds, clinical assessment, and differential diagnosis: reliability and validity in patients with myogenic pain. Pain. 1989;39(2):157–169. doi: 10.1016/0304-3959(89)90003-1.
    1. Eftekharsadat B, Porjafar E, Eslamian F, Shakouri SK, Fadavi HR, Raeissadat SA, et al. Combination of exercise and acupuncture versus acupuncture alone for treatment of myofascial pain syndrome: a randomized clinical trial. J Acupunct Meridian Stud. 2018;11(5):315–322. doi: 10.1016/j.jams.2018.04.006.
    1. Nabeta T, Kawakita K. Relief of chronic neck and shoulder pain by manual acupuncture to tender points–a sham-controlled randomized trial. Complement Ther Med. 2002;10(4):217–222. doi: 10.1016/S0965-2299(02)00082-1.
    1. Kawakita K, Okada K. Mechanisms of action of acupuncture for chronic pain relief—polymodal receptors are the key candidates. Acupunct Med. 2006;24:58–66. doi: 10.1136/aim.24.Suppl.58.
    1. Zucker NA, Tsodikov A, Mist SD, Cina S, Napadow V, Harris RE. evoked pressure pain sensitivity is associated with differential analgesic response to verum and sham acupuncture in fibromyalgia. Pain Med. 2017;18(8):1582–1592. doi: 10.1093/pm/pnx001.
    1. Jia P, Liu J, Li L, Luo Y, Li Y, Zhao L, et al. Acupuncture for knee osteoarthritis with sensitized acupoints: results from a pilot, feasibility randomized controlled trial. Pilot Feasibility Stud. 2020;6:144. doi: 10.1186/s40814-020-00687-x.
    1. Hey SP, Weijer C. Assay sensitivity and the epistemic contexts of clinical trials. Perspect Biol Med. 2013;56(1):1–17. doi: 10.1353/pbm.2013.0002.
    1. Tang L, Jia P, Zhao L, Kang D, Luo Y, Liu J, et al. Acupuncture treatment for knee osteoarthritis with sensitive points: protocol for a multicentre randomised controlled trial. BMJ Open. 2018;8(10):e023838. doi: 10.1136/bmjopen-2018-023838.
    1. MacPherson H, Altman DG, Hammerschlag R, Youping L, Taixiang W, White A, et al. Revised STandards for reporting interventions in clinical trials of acupuncture (STRICTA): extending the CONSORT statement. PLoS Med. 2010;7(6):e1000261. doi: 10.1371/journal.pmed.1000261.
    1. Chen WH, Liu XX, Tong PJ, Zhan HS. Diagnosis and management of knee osteoarthritis: Chinese medicine expert consensus (2015) Chin J Integr Med. 2016;22(2):150–153. doi: 10.1007/s11655-015-2432-7.
    1. Han L, Zhe M, Zhenzhen F, Cili Z, Guizhi Z, Jimeng Z, et al. The rule of acupoints' selection in acupuncture and moxibustion for knee osteoarthritis in clinic using data mining analysis. World Sci Tech/Modernization Trad Chin Med Materia Medica. 2016;18(08):1233–1240.
    1. Yuan HW, Ma LX, Zhang P, Lin C, Qi DD, Li J, et al. An exploratory survey of deqi sensation from the views and experiences of chinese patients and acupuncturists. Evid Based Complement Alternat Med. 2013;2013:430851.
    1. Xie F, Li SC, Goeree R, Tarride JE, O'Reilly D, Lo NN, et al. Validation of Chinese western ontario and mcmaster universities osteoarthritis index (WOMAC) in patients scheduled for total knee replacement. Qual Life Res. 2008;17(4):595–601. doi: 10.1007/s11136-008-9340-7.
    1. Lam CL, Tse EY, Gandek B. Is the standard SF-12 health survey valid and equivalent for a Chinese population? Qual Life Res. 2005;14(2):539–547. doi: 10.1007/s11136-004-0704-3.
    1. Zhao ZQ. Neural mechanism underlying acupuncture analgesia. Prog Neurobiol. 2008;85(4):355–375. doi: 10.1016/j.pneurobio.2008.05.004.
    1. Chang H-T. Neurophysiological interpretation of acupuncture analgesia. Endeavour. 1980;4(3):92–96. doi: 10.1016/0160-9327(80)90054-X.
    1. Lund I, Lundeberg T. Effects triggered in the periphery by acupuncture. Acupunct Relat Ther. 2015;3:24–34. doi: 10.1016/j.arthe.2015.08.002.
    1. Kong J, Gollub R, Huang T, Polich G, Napadow V, Hui K, et al. Acupuncture de qi, from qualitative history to quantitative measurement. J Altern Complement Med. 2007;13(10):1059–1070. doi: 10.1089/acm.2007.0524.
    1. Hole K, Berge O-G. Regulation of pain sensitivity in the central nervous system. Cephalalgia. 1981;1(1):51–59. doi: 10.1111/j.1468-2982.1981.tb00008.x.
    1. Tian DS, Xiong J, Pan Q, Liu F, Wang L, Xu SB, et al. De qi, a threshold of the stimulus intensity, elicits the specific response of acupoints and intrinsic change of human brain to acupuncture. Evid Based Complement Alternat Med. 2014;2014:914878. doi: 10.1155/2014/914878.
    1. Sun N, Wang LQ, Shao JK, Zhang N, Zhou P, Fang SN, et al. An expert consensus to standardize acupuncture treatment for knee osteoarthritis. Acupunct Med. 2020;38(5):327–334. doi: 10.1177/0964528419900789.
    1. Hmamouchi I, Allali F, Tahiri L, Khazzani H, Mansouri LE, AliOu Alla S, et al. Clinically important improvement in the WOMAC and predictor factors for response to non-specific non-steroidal anti-inflammatory drugs in osteoarthritic patients: a prospective study. BMC Res Notes. 2012;5:58. doi: 10.1186/1756-0500-5-58.
    1. Deyle GD, Allen CS, Allison SC, Gill NW, Hando BR, Petersen EJ, et al. Physical therapy versus glucocorticoid injection for osteoarthritis of the knee. N Engl J Med. 2020;382(15):1420–1429. doi: 10.1056/NEJMoa1905877.
    1. Allen KD, Woolson S, Hoenig HM, Bongiorni D, Byrd J, Caves K, et al. Stepped exercise program for patients with knee osteoarthritis : a randomized controlled trial. Ann Intern Med. 2021;174(3):298–307. doi: 10.7326/M20-4447.
    1. Melchart D, Weidenhammer W, Streng A, Reitmayr S, Hoppe A, Ernst E, et al. Prospective investigation of adverse effects of acupuncture in 97 733 patients. Arch Intern Med. 2004;164(1):104–105. doi: 10.1001/archinte.164.1.104.
    1. White A, Hayhoe S, Hart A, Ernst E. Survey of adverse events following acupuncture (SAFA): a prospective study of 32,000 consultations. Acupunct Med. 2001;19(2):84–92. doi: 10.1136/aim.19.2.84.
    1. Jevsevar DS. Treatment of osteoarthritis of the knee evidence-based guideline, 2nd edition. J Am Acad Orthop Surg. 2013;21(9):571–576.
    1. Chen H, Yang M, Ning Z, Lam WL, Zhao YK, Yeung WF, et al. A guideline for randomized controlled trials of acupuncture. Am J Chin Med. 2019;47(1):1–18. doi: 10.1142/S0192415X19500010.

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