Chronic knee pain associated with osteoarthritis (OA) is a leading cause of physical disability and health care resource utilization for older Americans. A minority of patients requires total joint replacement. Those intolerant or unresponsive to traditional analgesics have limited therapeutic options. Opioids have potentially morbid side effects in frail older adults. Glucosamine and chondroitin, intra-articular corticosteroids and hyaluronic acid, and arthroscopic debridement and lavage have either been only modestly effective or not helpful at all. Because of the frequent inefficacy of traditional medications, patients with painful rheumatologic disorders such as knee OA not infrequently seek complementary and alternative modalities, with acupuncture being one of the most common. Methodologic constraints prevent definitive conclusions regarding the benefits of acupuncture for OA-associated knee pain being drawn from existing studies. Periosteal electroacupuncture (osteopuncture) is a more potent modality than traditional Chinese acupuncture (TCA), with which we have had very positive clinical results, and it is just as safe and easy to perform.
We aim to validate our clinical experience with this randomized controlled pilot study by reducing pain severity and disability in community-dwelling older adults with OA-associated chronic knee pain. 88 older adults with persistent knee pain and x-ray evidence of OA, no other rheumatologic disorders, no history of knee surgery, and no prominent pain in sites other than the knee(s) will be randomized to receive either osteopuncture or control osteopuncture once a week for 6 weeks. All outcome measures will be collected pre-treatment, at the completion of the 6-week protocol, and 3 months later. The primary outcomes are pain and disability, measured with the Western Ontario and McMaster Universities Osteoarthritis Index. Secondary outcomes include physical performance, psychosocial function (mood, self-efficacy, coping, fear, self-rated health), sleep and appetite. If this preliminary study suggests that osteopuncture is an effective analgesic for OA-associated chronic knee pain, future studies will be designed that include physical reconditioning to optimize physical and psychosocial function, longer follow-up periods to determine duration of effects, and multiple dosing protocols to optimize the cost-benefit ratio. In addition, mechanisms of action will be explored, and the impact of osteopuncture on health care costs determined.
| Morone, Natalia E; Karp, Jordan F; Lynch, Cheryl S et al. (2009) Impact of chronic musculoskeletal pathology on older adults: a study of differences between knee OA and low back pain. Pain Med 10:693-701 |
| Weiner, Debra K; Rudy, Thomas E; Morone, Natalia et al. (2007) Efficacy of periosteal stimulation therapy for the treatment of osteoarthritis-associated chronic knee pain: an initial controlled clinical trial. J Am Geriatr Soc 55:1541-7 |
