Dr. Suarez-Almazor is the Director of the Houston Center for Education and Research on Therapeutics
A randomized controlled trial of acupuncture for osteoarthritis of the knee: Effects of patient-provider communication†
Article first published online: 2 SEP 2010
Copyright © 2010 by the American College of Rheumatology
Arthritis Care & Research
Volume 62, Issue 9, pages 1229–1236, September 2010
How to Cite
Suarez-Almazor, M. E., Looney, C., Liu, Y., Cox, V., Pietz, K., Marcus, D. M. and Street, R. L. (2010), A randomized controlled trial of acupuncture for osteoarthritis of the knee: Effects of patient-provider communication. Arthritis Care Res, 62: 1229–1236. doi: 10.1002/acr.20225
ClinicalTrials.gov identifier: NCT00059345.
- Issue published online: 2 SEP 2010
- Article first published online: 2 SEP 2010
- Accepted manuscript online: 21 APR 2010 12:00AM EST
- Manuscript Accepted: 8 APR 2010
- Manuscript Received: 22 SEP 2009
- National Institute of Arthritis and Musculoskeletal and Skin Disorders. Grant Number: R01-AR49999
- K24 career award from the National Institute of Arthritis and Musculoskeletal and Skin Disorders
- Agency for Health Research and Quality. Grant Number: U18-HS016093
There is conflicting evidence on the efficacy of traditional Chinese acupuncture (TCA), and the role of placebo effects elicited by acupuncturists' behavior has not been elucidated. We conducted a 3-month randomized clinical trial in patients with knee osteoarthritis to compare the efficacy of TCA with sham acupuncture and to examine the effects of acupuncturists' communication styles.
Acupuncturists were trained to interact in 1 of 2 communication styles: high or neutral expectations. Patients were randomized to 1 of 3 style groups, waiting list, high, or neutral, and nested within style, TCA or sham acupuncture twice a week over 6 weeks. Sham acupuncture was performed in nonmeridian points with shallow needles and minimal stimulation. Primary outcome measures were Joint-Specific Multidimensional Assessment of Pain (J-MAP), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and satisfaction scores.
Patients (n = 455) received treatment (TCA or sham) and 72 controls were included. No statistically significant differences were observed between TCA or sham acupuncture, but both groups had significant reductions in J-MAP (−1.1, −1.0, and −0.1, respectively; P < 0.001) and WOMAC pain (−13.7, −14, and −1.7, respectively; P < 0.001) compared with the waiting group. Statistically significant differences were observed in J-MAP pain reduction and satisfaction, favoring the high expectations group. In the TCA and sham groups, 52% and 43%, respectively, thought they had received TCA (κ = 0.05), suggesting successful blinding.
TCA was not superior to sham acupuncture. However, acupuncturists' styles had significant effects on pain reduction and satisfaction, suggesting that the analgesic benefits of acupuncture can be partially mediated through placebo effects related to the acupuncturist's behavior.