title: Acupuncture for chronic knee pain: a randomized clinical trial.
abstract: OBJECTIVE
  There is debate about benefits of acupuncture for knee pain.
  
  
  OBJECTIVE
  To determine the efficacy of laser and needle acupuncture for chronic knee pain.
  
  
  METHODS
  Zelen-design clinical trial (randomization occurred before informed consent), in Victoria, Australia (February 2010-December 2012). Community volunteers (282 patients aged ≥50 years with chronic knee pain) were treated by family physician acupuncturists.
  
  
  METHODS
  No acupuncture (control group, n = 71) and needle (n = 70), laser (n = 71), and sham laser (n = 70) acupuncture. Treatments were delivered for 12 weeks. Participants and acupuncturists were blinded to laser and sham laser acupuncture. Control participants were unaware of the trial.
  
  
  METHODS
  Primary outcomes were average knee pain (numeric rating scale, 0 [no pain] to 10 [worst pain possible]; minimal clinically important difference [MCID], 1.8 units) and physical function (Western Ontario and McMaster Universities Osteoarthritis Index, 0 [no difficulty] to 68 [extreme difficulty]; MCID, 6 units) at 12 weeks. Secondary outcomes included other pain and function measures, quality of life, global change, and 1-year follow-up. Analyses were by intention-to-treat using multiple imputation for missing outcome data.
  
  
  RESULTS
  At 12 weeks and 1 year, 26 (9%) and 50 (18%) participants were lost to follow-up, respectively. Analyses showed neither needle nor laser acupuncture significantly improved pain (mean difference; -0.4 units; 95% CI, -1.2 to 0.4, and -0.1; 95% CI, -0.9 to 0.7, respectively) or function (-1.7; 95% CI, -6.1 to 2.6, and 0.5; 95% CI, -3.4 to 4.4, respectively) compared with sham at 12 weeks. Compared with control, needle and laser acupuncture resulted in modest improvements in pain (-1.1; 95% CI, -1.8 to -0.4, and -0.8; 95% CI, -1.5 to -0.1, respectively) at 12 weeks, but not at 1 year. Needle acupuncture resulted in modest improvement in function compared with control at 12 weeks (-3.9; 95% CI, -7.7 to -0.2) but was not significantly different from sham (-1.7; 95% CI, -6.1 to 2.6) and was not maintained at 1 year. There were no differences for most secondary outcomes and no serious adverse events.
  
  
  CONCLUSIONS
  In patients older than 50 years with moderate or severe chronic knee pain, neither laser nor needle acupuncture conferred benefit over sham for pain or function. Our findings do not support acupuncture for these patients.
  
  
  BACKGROUND
  anzctr.org.au Identifier: ACTRN12609001001280.
authors.affiliation: Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, School of Health Sciences, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia.
authors.forename: Rana S
authors.initials: RS
authors.lastname: Hinman
authors.affiliation: Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, School of Health Sciences, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia2Florey Institute of Neuroscience and Mental Health.
authors.forename: Paul
authors.initials: P
authors.lastname: McCrory
authors.affiliation: Department of General Practice, School of Medicine, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia.
authors.forename: Marie
authors.initials: M
authors.lastname: Pirotta
authors.affiliation: Department of General Practice, School of Medicine, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia.
authors.forename: Ian
authors.initials: I
authors.lastname: Relf
authors.affiliation: Epidemiology and Preventative Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia.
authors.forename: Andrew
authors.initials: A
authors.lastname: Forbes
authors.affiliation: Division of Physiotherapy, School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Australia.
authors.forename: Kay M
authors.initials: KM
authors.lastname: Crossley
authors.affiliation: Farr Institute of Health Informatics Research, London, United Kingdom7Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, United Kingdom.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Williamson
authors.affiliation: Department of General Practice, School of Medicine, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia.
authors.forename: Mary
authors.initials: M
authors.lastname: Kyriakides
authors.affiliation: Department of General Practice, School of Medicine, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia.
authors.forename: Kitty
authors.initials: K
authors.lastname: Novy
authors.affiliation: Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, School of Health Sciences, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia.
authors.forename: Ben R
authors.initials: BR
authors.lastname: Metcalf
authors.affiliation: Centre for Health Economics, Faculty of Business and Economics, Monash University, Melbourne, Australia.
authors.forename: Anthony
authors.initials: A
authors.lastname: Harris
authors.affiliation: School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, Newcastle, Australia.
authors.forename: Prasuna
authors.initials: P
authors.lastname: Reddy
authors.affiliation: Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds and NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds, United Kingdom.
authors.forename: Philip G
authors.initials: PG
authors.lastname: Conaghan
authors.affiliation: Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, School of Health Sciences, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia.
authors.forename: Kim L
authors.initials: KL
authors.lastname: Bennell
mesh_terms: D015670:Acupuncture Therapy / Q000009:adverse effects / Q000379:methods; D000368:Aged; D000700:Analgesics / Q000627:therapeutic use; D059350:Chronic Pain / Q000188:drug therapy / Q000628:therapy*; D005260:Female; D006801:Humans; D007717:Knee; D028022:Low-Level Light Therapy / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
chemical_list: D000700:Analgesics