Features - 'Acupuncture and Arthritis'

Electro-Acupuncture & Hydrotherapy Combined With Patient Education Improves Symptoms of Hip Osteoarthritis

15 patients with osteoarthritis of the hip were randomised to EA with patient education, 15 to hydrotherapy with patient education, and 15 to patient education alone. All patients were treated twice a week for 5 weeks, with each treatment lasting 30 minutes. Efficacy was evaluated using the disability rating index (DRI) to assess functional ability, the global self-rating index (GSI) to assess quality-of-life, and the visual analogue scale (VAS) to assess pain (ie, pain related to motion and pain on load, as well as ache during the day and night).

As shown by VAS scores, patients treated with combination EA and patient education had a significant improvement in pain up to 6 months after treatment, a reduction in ache during the day up to 3 months after treatment, and a reduction in ache during the night up to 6 months after treatment.

Patients treated with combination hydrotherapy and patient education had significant improvement in pain up to 3 months after treatment, a reduction in ache during the day up to 3 months after treatment, and a reduction of ache during the night up to 1 month after treatment but no significant reduction after 6 months. No significant changes in pain or ache occurred in the patient education alone group.

As shown by DRI, functional activities significantly improved in patients treated with combination EA and patient education 6 months after last treatment. In the hydrotherapy and patient education group, DRI was significantly reduced compared to baseline measures after up to 3 months of treatment, but was not significantly reduced after 6 months. In the patient education only group, the DRI significantly increased after 6 months.

Quality of life was significantly improved in both the EA and hydrotherapy combination groups, with a significant reduction in GSI up to 3 months after treatment for both groups. No significant reduction was seen in the patient education alone group.

Authors Conclusion

The authors conclude that "EA and hydrotherapy, both in combination with patient education, induce long-lasting effects, demonstrated by reduced pain and ache and by increased functional activity and quality of life," and that the "pain relief was more long lasting, up to 6 months, in the EA group."

Clin J Pain 2004 May;20:3:179-185

Comment: There are many methods of applying hydrotherapy, including baths, saunas, douches, wraps, and packs. Water therapy has been around for centuries and can be very effective. Electoacupuncture is a modern method of applying acupuncture. It uses the same points but the needles are attached to a device that generates continuous electric pulses. It is especially useful in chronic pain conditions but has quite a wide application.

Clues Found To How Acupuncture Works

Acupuncture on pain-relief points cuts blood flow to key areas of the brain within seconds, providing the clearest explanation to date for how the ancient technique might relieve pain and treat addictions.

Although researchers still don't fully understand how acupuncture works, “our findings may connect the dots, showing how a common pathway in the brain could make acupuncture helpful for a variety of conditions,” says radiologist Bruce Rosen of Harvard Medical School.

Rosen's team used functional Magnetic Resonance Imaging, or MRIs, on about 20 healthy volunteers before, during and after acupuncture. This type of brain scan shows changes in blood flow and the amount of oxygen in blood.

Researchers applied acupuncture needles to points on the hand linked to pain relief in traditional Chinese medicine. Blood flow decreased in certain areas of the brain within seconds of volunteers reporting a heaviness in their hands, a sign the acupuncture is working correctly, Rosen says.

The needle technique is not supposed to hurt if done correctly. When a few subjects reported pain, their scans showed an increase of blood to the same brain areas.

“When there's less blood, the brain isn't working as hard,” Rosen says. “In effect, acupuncture is quieting down key regions of the brain.”

The specific brain areas affected are involved in mood, pain and cravings, Rosen says. This could help explain why some studies have found acupuncture helpful in treating depression, eating problems, addictions and pain.

The brain regions involved also are loaded with dopamine, a “reward” chemical that surges in reaction to everything from cocaine to food, beautiful faces and money. The reduced blood flow could lead to dopamine changes that trigger a “cascade” effect, releasing endorphins, the brain's natural pain-relieving and comforting chemicals, Rosen says.

USA Today 3rd March, 2004

Comment: This is a fascinating study but another study should be performed where patients are divided into 2 groups. One groups gets acupuncture and another group gets sham acupuncture. Or one group gets acupuncture at real acupuncture points while the other group gets it at bogus acupuncture points. Patients should be unaware which group they are in. This type of blind study is much more convincing.

Fact is that the placebo effect is so powerful it could affect blood flow. There's even some evidence that placebos can increase brain chemicals, such as endorphins.

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Page Created: 9 May 2005