Acupuncture Treatment of Lateral Elbow Pain: A Nonrandomized Pilot Study

This nonrandomized pilot study investigated the efficacy of manual acupuncture in the treatment of lateral epicondylitis, popularly known as tennis elbow. The research was conducted in China between February and December 2012, with the goal of providing information to plan a large-scale international multicenter clinical trial. Lateral epicondylitis is a painful condition that affects the elbow and can cause significant functional limitations in patients' daily lives. Forty adults aged 18 to 70 years, who had suffered lateral elbow pain for at least three months, were divided into two groups: 20 received manual acupuncture and 20 received control treatment with inactive laser (sham-laser).

The acupuncture group received needling at points LI-11 (Quchi) and LI-10 (Shousanli) on the affected side, using sterile stainless steel needles. The manual manipulation technique was based on the traditional 'green dragon shakes its tail' method, applied by an experienced acupuncturist. The needles were inserted until the De Qi sensation was obtained and were retained for 25 minutes, with specific manipulation at each point. The control group received application of an inactive laser (LED) device at the same acupuncture points, with duration and frequency identical to the treatment group.

Both groups completed nine sessions over three weeks, followed by a two-week follow-up period. The researchers evaluated three primary outcome measures: the DASH (Disabilities of the Arm, Shoulder, and Hand) questionnaire to assess functional limitation, pain-free grip strength using a dynamometer, and pain intensity through the visual analog scale at rest, with movement, and on exertion. Assessments were performed before treatment, at the 4th, 7th, and 9th sessions, and at the two-week follow-up. The results demonstrated statistically significant differences between groups at the end of treatment.

The DASH questionnaire proved to be the most sensitive measure, showing significant differences as early as the 4th treatment session. Pain-free grip strength improved significantly starting at the 7th session, while pain measures showed consistent improvements, especially at the 9th session. Importantly, both groups considered their respective treatments equally credible, validating the use of sham-laser as an appropriate control. The acupuncture group showed sustained improvements in all measures during the two-week follow-up, suggesting lasting treatment effects.

The researchers reported no adverse events during the study. The clinical implications are promising, as they demonstrate that manual acupuncture with a standardized technique may be effective for lateral epicondylitis. The study provided valuable information about the feasibility of the treatment protocol, sensitivity of the outcome measures, and credibility of the control, essential elements for planning the subsequent multicenter trial. However, important limitations should be considered when interpreting the results.

The nonrandomized design, with groups formed at different periods, may have introduced selection bias and confounders. The inclusion of unilateral cases only may limit generalizability of the findings. The small sample size, although adequate for a pilot, requires confirmation in larger studies to definitively establish the efficacy of acupuncture in this condition.