Acupuncture for Osteoarthritis

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Osteoarthritis

Osteoarthritis is a chronic condition in which the material that cushions the joints, called cartilage, breaks down. This causes the bones to rub against each other, causing stiffness, pain and loss of mobility.It is important to pay attention to your body because osteoarthritis symptoms usually develop gradually. At first, there may be soreness or stiffness that seems more like a nuisance than something that needs attention.  Think of this as a warning light on the car.   Taking Ibuprofen may get rid of the warning light but does not fix the problem.

 

Common symptoms of osteoarthritis include sore or stiff joints, particularly the hips, knees, and lower back – after inactivity or overuse.  In Chinese Medicine we take into account whether or not the pain is worse after resting or worse after activity.

  • Stiffness after resting or pain that goes away after movement is caused by “stagnation”. A treatment approach would focus on stimulation and movement with acupuncture and possibly herbs, especially topical herbs.
  • Pain that is worse after activity or at the end of the day may be one of “deficiency”, therefore we would base our treatments on strengthening the body.
  • We also take into account whether the pain is worse in cold weather or damp weather or both.
Osteoarthritis may also affect the neck, small finger joints, the base of the thumb, ankle, and big toe. The pain may be moderate and come and go, without affecting the ability to perform daily tasks.  Some people’s osteoarthritis will never progress past this early stage. Others will have their osteoarthritis get worse. The pain and stiffness of more severe osteoarthritis may make it difficult to walk, climb stairs, sleep, or perform other daily tasks.

 

Common Causes of Osteoarthritis

  • Genetics – There are 3 genes that have been identified and correlated with OA.  Because you have one or more of these genes does not mean you will get OA.  The genes are just the hardware as it is the environment, also known as the epigenetics (or software) that dictate how the genes are turned on and off.  But having the genes may increase your risk.
  • Knee injuries – If you had some sort of cartilage damage such as a meniscus tear or ligament damage this can lead to osteosarthritis later in life.   The tissue damage in the joint will lead to more inflammation thereby causing more knee damage. Your genetic makeup can dictate whether you go on to develop arthritis.
  • Obesity and overweight -If you are carrying extra weight on your joints then you put more stress on the joints.  It is basic biomechanics where the joint is asked to do more.  Also as we age our skeletal structure is more likely to be misaligned and this puts more stress on the joint. In addition, having a high Basal Metabolic Index (BMI) can contribute to osteoarthritis because of a chemical messenger called Leptin.  Leptin is known as the  “satiety hormone”  is made by fat cells and regulates body fat storage.  The higher the leptin levels the greater the likelihood of osteoarthritis independent of BMI.
  • Wear and Tear and Aging– People that do a lot of twisting and turning with the knees from various sports can develop osteoarthritis over time.  Also as we get older we generally carry a higher inflammatory load and this translates to increased inflammation in the joints and other body parts.  What does that mean?  More discomfort and pain as we age. To put it in simpler terms we have more “free radicals” as we age and too high a level of free radicals can cause significant damage to cells.  More damage to cells can lead to more pain.  (Our inflammatory and thus free radical load can be greatly reduced by diet and lifestyle.)

Acupuncture Helps Improve Osteoarthritis Symptoms

A very recent paper was published that reviewed 12 previously published studies regarding the use of acupuncture for osteoarthritis.   This type of research paper is called a meta-analysis as it combines data of many previously released studies to draw a potentially new conclusion.  It is sort of like conducting research about previously released research but using the power of many studies and methods to draw upon.  There were 12 studies chosen to be pooled together and the collected studies consisted of more than 1700 osteoarthritis participants.

What they concluded from this study is that acupuncture is an effective modality for osteoarthritis:

The use of acupuncture is associated with significant reductions in pain intensity, improvement in functional mobility and quality of life….current evidence supports the use of acupuncture as an alternative for traditional analgesics in patients with osteoarthritis.
Pain management with acupuncture in osteoarthritis: a systematic review and meta-analysis,Manyanga T, Froese,M, et al.

Osteoarthritis is not a modern disease as Chinese Medicine has a long documented history of treating this described pathology.  The ancient medical texts of course did not call it osteoarthritis, but rather different types of “Bi syndrome”.  Acupuncture and Chinese Medicine have successfully been treating a common disease for centuries. So I would suggest that acupuncture should be a primary treatment modality for osteoarthritis.

Chinese Medicine also prescribes exercises for these conditions.  So working with a physical therapist and/or incorporating home exercises is an essential adjunct to the acupuncture treatments.  In addition I typically use topical herbs that are clinically quite effective for reducing pain,especially from cold.   For patients that can predict the weather before their symptoms begin there are several internal herbal formulas that are quite effective.

The frequency and number of treatments you would need to receive depends upon the severity of your condition and how well you take care of yourself during the day.   Typically patients would come in for 1 session per week for a few weeks then we would cut back to every other week for a couple of months.  Ideally coming in for a ‘tune up’ every 3-12 weeks after an initial course of 1-2 months of treatments usually suffices.  Treatment plans are very much dependent on each individual’s health and personal self-care. The additional beauty of acupuncture is that it is not just your knee which gets treated but your entire body as well, so people report feeling more relaxed, sleeping better, better mood etc.

As a side note, if all insurance companies covered acupuncture for osteoarthritis it would likely save them many millions in delaying or avoiding expensive joint replacement. For almost all insurance companies that do cover acupuncture they will pay for osteoarthritis of the knee as many studies have demonstrated its effectiveness. However a lack of insurance coverage should not preclude seeking treatments since quality acupuncture sessions are quite affordable compared to other medical out-of-pocket expenses.

Yours In Health,
George Mandler

References

1.

Manyanga T1, Froese M, Zarychanski R, Abou-Setta A, Friesen C, Tennenhouse M, Shay BL. Pain management with acupuncture in osteoarthritis: a systematic review and meta-analysis. BMC Complement Altern Med. 2014 Aug 23;14:312. PMID: 25151529. [PubMed] [Read by QxMD]

2.

O’Donovan A1, Pantell MS, Puterman E, Dhabhar FS, Blackburn EH, Yaffe K, Cawthon RM, Opresko PL, Hsueh WC, Satterfield S, Newman AB, Ayonayon HN, Rubin SM, Harris TB, Epel ES; Health Aging and Body Composition Study. Cumulative inflammatory load is associated with short leukocyte telomere length in the Health, Aging and Body Composition Study. PLoS One. 2011;6(5):e19687. PMID: 21602933. [PubMed] [Read by QxMD]

3.

Cao L1, Zhang XL, Gao YS, Jiang Y. Needle acupuncture for osteoarthritis of the knee. A systematic review and updated meta-analysis. Saudi Med J. 2012 May;33(5):526-32. PMID: 22588814. [PubMed] [Read by QxMD]

4.

Tukmachi E1, Jubb R, Dempsey E, Jones P. The effect of acupuncture on the symptoms of knee osteoarthritis–an open randomised controlled study. Acupunct Med. 2004 Mar;22(1):14-22. PMID: 15077933. [PubMed] [Read by QxMD]

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Kwon YD1, Pittler MH, Ernst E. Acupuncture for peripheral joint osteoarthritis: a systematic review and meta-analysis. Rheumatology (Oxford). 2006 Nov;45(11):1331-7. PMID: 16936326. [PubMed] [Read by QxMD]

6.

Ezzo J1, Hadhazy V, Birch S, Lao L, Kaplan G, Hochberg M, Berman B. Acupuncture for osteoarthritis of the knee: a systematic review. Arthritis Rheum. 2001 Apr;44(4):819-25. PMID: 11315921. [PubMed] [Read by QxMD]

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White A1, Foster NE, Cummings M, Barlas P. Acupuncture treatment for chronic knee pain: a systematic review. Rheumatology (Oxford). 2007 Mar;46(3):384-90. PMID: 17215263. [PubMed] [Read by QxMD]

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