Different kinds of acupuncture treatments for knee osteoarthritis: a multicentre, randomized controlled trial

Knee osteoarthritis, scientifically known as osteoarthritis of the knee, is a condition that affects millions of people around the world, especially those over 60 years of age. The disease causes persistent pain, joint stiffness, numbness, limited range of motion, and, in more severe cases, can lead to disability. The personal and social costs associated with this condition are substantial, profoundly affecting patients' quality of life. With the aging of the world's population, osteoarthritis is projected to become the fourth most disabling disease by 2020, making the search for effective and safe treatments urgent.

Currently, treatment of knee osteoarthritis is based primarily on the use of nonsteroidal anti-inflammatory drugs, such as celecoxib and acetaminophen, along with supplements such as glucosamine and chondroitin. Although these medications can provide pain relief, they have important limitations. Acetaminophen, for example, has limited analgesic effect and, when used in high doses, can cause liver damage and gastrointestinal toxicity. These limitations of conventional treatments have led patients and healthcare professionals to seek safer and more effective therapeutic alternatives.

In that context, acupuncture has gained growing recognition as a promising therapeutic option for the management of chronic pain associated with knee osteoarthritis.

This study was developed with the objective of investigating the efficacy of three different types of acupuncture treatments for knee osteoarthritis, comparing them with each other and with control treatments. The research is a randomized, controlled, multicenter clinical trial involving six hospitals in Zhejiang Province, China. The study will include 360 patients with knee osteoarthritis, who will be randomly divided into six treatment groups: traditional acupuncture, electroacupuncture, mild moxibustion, warm-needling acupuncture, sham acupuncture, and celecoxib treatment. Each group will receive twelve treatment sessions over four weeks, at three sessions per week.

The investigators used rigorous criteria for participant selection, including individuals aged 40 to 75 years with a confirmed diagnosis of knee osteoarthritis and persistent pain for at least three months.

The main outcomes of the study will be measured through standardized scales that assess different aspects of the patients' condition. Pain intensity will be assessed using a visual analog scale, on which patients indicate their pain level on a 0-to-10 scale. Physical function will be measured by the WOMAC index, which assesses patients' ability to perform daily activities such as walking, climbing stairs, and performing household tasks. In addition, the investigators will assess other important aspects such as joint stiffness, level of physical activity, knee swelling, and overall quality of life.

These measurements will be performed at five different time points: before treatment, after two weeks, after four weeks, and at three- and six-month follow-up assessments after the end of treatment. This approach will allow investigators to observe both immediate effects and long-term benefits of the different treatments.

For patients with knee osteoarthritis, the results of this study may have important implications for their future treatment options. The research aims to clarify which type of acupuncture is most effective for reducing pain and improving joint function, providing robust scientific evidence that may guide therapeutic decisions. For healthcare professionals, this study will provide comparative data across different acupuncture modalities, enabling more informed choices about which technique to use for each patient. The inclusion of a control group with an established medication (celecoxib) and another with sham acupuncture strengthens the credibility of the results, allowing valid comparisons between traditional and alternative treatments.

If the results confirm the efficacy of acupuncture techniques, this may lead to greater acceptance and integration of these therapies into standard treatment protocols for knee osteoarthritis.

The study has some important limitations that should be considered when interpreting the results. One of the main limitations is the difficulty of maintaining patient blinding, especially in those who have had prior experience with acupuncture. To minimize this issue, the investigators will conduct each treatment in separate rooms and will keep assessors and statisticians blinded to the treatment groups. Another important consideration is that, although the study is multicenter and involves a substantial number of participants, the results may be specific to the Chinese population studied and may have limited applicability to other populations.

In addition, as in any acupuncture study, there is the possibility of placebo effects influencing the results, although the inclusion of a sham acupuncture group helps to control for this factor. Despite these limitations, this study represents a significant advance in research on acupuncture for knee osteoarthritis, providing rigorous scientific evidence on the efficacy and safety of these complementary therapies.