Acupuncture and Osteoarthritis: Practices and Evidences
Pp. 81-93 (13)
Acupuncture is recommended as a non-pharmacological treatment option for patients with
knee and hip osteoarthritis (OA). Acupuncture is a Chinese philosophy which aims to restore the body
to normal health. The explained mechanisms consider that acupuncture nociceptive pathways are
essential for acupuncture analgesia, which is mediated by different endogenous neurotransmitters, such
as enkephalin and dynorphin, and probably decreases the local inflammatory response via N-methyl-daspartate
receptors. Acupuncture increases pain threshold gradually, with a peak effect at 20-40 min; a
tolerance mediated by choleystokinin octapeptide could be observed if a prolonged period of
acupuncture stimulation is performed. Immunocytochemistry and imaging studies indicate that both
pain and acupuncture activate the hypothalamicpituitary-adrenocortical axis.
The literature review shows that clinical effects are small when acupuncture is compared with sham for
treating OA patients; however, few if any other commonly used treatments for OA meet the threshold for
clinically relevant benefits. On the other hand, acupuncture exceeds the thresholds for clinical relevance
when compared with a waiting list control and with some other active treatment control, but the absence of
sham treatment as a control suggests that benefits are primarily due to expectation or placebo effects.
Osteoarthritis, acupuncture, pain.