Acupuncture found as effective as celecoxib in treating knee osteoarthritis with imaging evidence

Introduction

A research team from Chengdu University of TCM compared the modulation effects of acupuncture treatment with NSAIDs and placebo medication on descending pain modulation system (DPMS) in knee osteoarthritis (KOA) patients. This study recruited 180 KOA patients with knee pain and 41 healthy controls (HCs). Individuals with KOA knee pain were divided randomly into groups of verum acupuncture (VA), sham acupuncture (SA), celecoxib (SC), placebo (PB), and waiting list (WT), with 36 patients in each group.

Treatment

SP9, GB34, Neixiyan, Dubi.

NP refers to none-points as Sham acupuncture points.

Needling: 0.20*40 mm, Deqi

Acupoints and non-acupoints locations — acupuncture knee osteoarthritis

Two trained and licensed acupuncturists conducted all acupuncture treatments. All acupoints and non-acupoints on both sides of the body were pierced using small needles made of disposable stainless-steel measuring 0.25 mm to 40 mm in length (Hwato, China). When inserting the needles, the penetrating depth was kept between 0.5 cun and 1.5 cun. The locations in the VA and SA groups were gently manipulated to induce a specific acupuncture sensation (deqi).

Results

All groups demonstrated improved knee pain scores relative to the initial state. There was no statistical difference between the VA and SA groups in all clinical outcomes, and vlPAG rs-FC alterations. KOA knee pain individuals reported higher vlPAG rs-FC in the bilateral thalamus than HCs. KOA knee pain patients in the acupuncture group (verum + sham, AG) exhibited increased vlPAG rs-FC with the right dorsolateral prefrontal cortex (DLPFC) and the right angular, which is associated with knee pain improvement. In contrast with the SC and PB group, the AG exhibited significantly increased vlPAG rs-FC with the right DLPFC and angular. Contrary to the WT group, the AG showed greater vlPAG rs-FC with the right DLPFC and precuneus.

Conclusions

Acupuncture treatment, celecoxib, and placebo medication have different modulation effects on vlPAG DPMS in KOA knee pain patients. Acupuncture could modulate vlPAG rs-FC with brain regions associated with cognitive control, attention, and reappraisal for knee pain relief in KOA patients, compared with celecoxib and placebo medication.