Efficacy of Different Acupuncture Techniques for Pain and Dysfunction in Patients with Knee Osteoarthritis: A Randomized Controlled Trial

Knee osteoarthritis represents one of the greatest medical challenges of today, especially for the elderly population. This degenerative joint condition affects approximately 10% of people over 60 years old worldwide, causing chronic pain, stiffness, and functional limitation that significantly reduce quality of life. About 30% of individuals over 45 years already show radiographic evidence of the disease, which increases healthcare costs and negatively impacts the well-being of those affected. Although pharmacological treatments, especially nonsteroidal anti-inflammatories such as celecoxib, are frequently used, they have important limitations due to side effects, including gastrointestinal discomfort, hepatic and renal problems, restricting their prolonged use.

In this context, non-pharmacological therapies such as acupuncture have gained prominence as effective and safe alternatives.

This multicenter study had as its main objective to investigate whether different acupuncture techniques are more effective in controlling pain and improving joint function than sham acupuncture or pharmacological treatment in patients with knee osteoarthritis, as well as to determine which technique presents better efficacy. To this end, the researchers conducted a randomized controlled, single-blind clinical trial, involving 360 participants from six hospitals in China. Participants, ages 40 to 75 years, were divided equally into six groups: manual acupuncture (basic technique with needling and manipulation), electroacupuncture (combining acupuncture with electrical stimulation), warm needle acupuncture (combining needles with moxa heating), mild moxibustion (heating with moxa without needles), sham acupuncture (placebo control), and treatment with celecoxib (pharmacological control). All treatments were performed for four consecutive weeks, three times per week, lasting 30 minutes each session.

The results clearly demonstrated that all studied acupuncture techniques were significantly more effective than sham acupuncture in pain relief and physical function improvement. When compared to the sham acupuncture control group, the real acupuncture techniques resulted in an average reduction of 0.61 points on the visual pain scale and a decrease of 13.84 points on the WOMAC physical function score, which specifically assesses functional limitations related to osteoarthritis. Among the different acupuncture techniques, electroacupuncture stood out as the most effective, presenting statistically significant superiority over manual acupuncture in pain reduction. Even more impressive was the comparison with pharmacological treatment: electroacupuncture demonstrated significant advantage over celecoxib, with an additional reduction of 1.14 points on the pain scale and 14.81 points on the physical function score.

These findings were consistent not only at the end of treatment, but also maintained during the six-month follow-up period.

For patients with knee osteoarthritis, these results represent an encouraging discovery, offering an effective and safe alternative to traditional medications. Electroacupuncture, in particular, emerges as a superior therapeutic option, potentially providing more effective pain relief than conventional anti-inflammatories, without the side effects associated with prolonged use of these medications. For healthcare professionals, the study provides robust evidence to guide the choice of the most appropriate acupuncture technique, suggesting that electroacupuncture should be considered as first-line among available acupuncture options. The proposed mechanisms for the superiority of electroacupuncture include its ability to stimulate the synthesis of endogenous analgesic neurotransmitters, strengthen the natural pain inhibitory system, and exert anti-inflammatory effects that improve local microcirculation and reduce bone destruction in the knee.

The observed safety profile was favorable, with a low incidence of acupuncture-related adverse events (5.96%), mainly minor local bleeding and, occasionally, dizziness. Comparatively, the group that received medication presented a slightly higher rate of adverse effects (9.26%), including gastrointestinal discomfort and drowsiness. It is important to recognize the limitations of this study. The fact that it was conducted predominantly in a Chinese population, familiar with acupuncture, may have influenced the results and limit generalization to other populations.

Participant blinding was partially compromised, since many were able to identify whether they were receiving real or sham acupuncture. Furthermore, even sham acupuncture demonstrated some benefit, suggesting possible placebo effects or inherent benefits of superficial needling.

Despite these limitations, this study represents a significant contribution to the field of integrative medicine, providing robust scientific evidence on the comparative efficacy of different acupuncture techniques for knee osteoarthritis. The findings suggest that acupuncture, especially electroacupuncture, should be considered an important therapeutic option in the management of this debilitating condition, offering patients an effective and safe alternative that can reduce dependence on medications with potential adverse effects. For the future, additional studies are needed with more diverse populations and improved blinding techniques to confirm and expand these promising results.