Should You Try Acupuncture to Treat Arthritis Pain?

From health.usnews.com

About 1 in 4, or more than 54 million, adults in the U.S. have arthritis, according to the Centres for Disease Control and Prevention.

The umbrella term describes various conditions that affect the joints and surrounding tissues. The most common type, osteoarthritis, involves the breakdown of cartilage in joints, such as the hips and knees, and it’s particularly prevalent as people get older.

“Osteoarthritis is a degenerative mechanical condition that causes loss of cartilage resulting often in joint pain and sometimes loss of function,” explains Dr. Charis Meng, a rheumatologist at the Hospital for Special Surgery and Weill Cornell Medicine in New York City. As with many causes of chronic pain, there’s no quick fix.

In some cases, surgery such as knee replacement is recommended to treat advanced osteoarthritis. That’s “probably the closest thing we come to a ‘cure’ quote unquote, because you’re replacing the joint,” Meng says.

Still, she and other experts reiterate that right now there’s no therapy to reverse the cartilage loss that happens inside the knee or another joint with OA. And for many surgery isn’t necessary or recommended, even while joint pain from arthritis may limit function and daily activities and undermine quality of life.

To try to tame that chronic pain and improve function, experts recommend everything from losing weight (to take stress off joints) to exercise to over-the-counter and prescription medication and injections of cortisone in the joints, depending on the individual, to ease discomfort.

In addition, some people turn to acupuncture – a form of traditional Chinese medicine that typically involves practitioners inserting ultra-thin needles into the skin – in an effort to relieve or reduce arthritis pain. “Right now we don’t have a medical cure. So we rely on treatment, and I look at acupuncture as a traditional treatment for osteoarthritis pain,” says Meng, who is certified in acupuncture. “I always make it clear it’s not a cure, because nobody’s replacing the cartilage with acupuncture or anything else for that matter in Western medicine.”

Practitioners say acupuncture may also help to relieve pain from rheumatoid arthritis, in which the body’s immune system “attacks” the joints, causing painful inflammation.

Where many with arthritis use more than one approach to address pain and improve function, Jamie Starkey, manager of the Eastern medicine program and lead acupuncturist at the Cleveland Clinic's Centre for Integrative and Lifestyle Medicine, sees it as complementing other options for treating arthritis. “It really oftentimes does take a multidisciplinary approach to care,” she says.

Acupuncture is a kind of traditional Chinese medicine where practitioners insert ultra-thin needles  into the skin. (Getty Images)

Along those lines, some research provides support for using acupuncture to treat arthritis. In general, the technique has been shown to reduce inflammation, and relieve various forms of chronic pain. Still, there’s also conflicting data, too.

A research review published last year in Evidence-Based Complementary and Alternative Medicine concluded “acupuncture alone or combined with other treatment modalities is beneficial to the clinical conditions of RA (rheumatoid arthritis) without adverse effects reported and can improve function and quality of life and is worth trying.” Another meta-analysis published in The Journal of Pain in 2018 found acupuncture to be effective for treating osteoarthritis pain, among other types of chronic pain, and that the benefits persist over time and pain relief can’t be explained solely by a placebo effect.

But experts reviewing studies on acupuncture to treat arthritis have bemoaned a dearth of high quality research in that area. Further complicating matters is the heterogeneity of acupuncture itself: That is, various practitioners use different techniques, rather than one uniform type of acupuncture being applied.

A 2010 Cochrane review, including studies of people with osteoarthritis in the peripheral joints (knee, hip and hand), found it conferred a small benefit, but owed that was at least partially related to placebo effect. The findings from a 2014 study published in the Journal of the American Medical Association didn’t support the use of acupuncture to relieve moderate or severe knee pain in individuals over 50 (which is typically the result of osteoarthritis). And a 2018 Cochrane review found: “Acupuncture probably has little or no effect in reducing pain or improving function relative to sham acupuncture in people with hip osteoarthritis.”

Despite mixed research results – which have been disputed by some practitioners – acupuncture is widely used to treat chronic pain, and data strongly supports its safety.

Almost anyone can have it done with little risk or discomfort. “If somebody has very limited mobility and has trouble getting onto the table – I have had this happen – maybe acupuncture is not the best thing for them, because they do have to lie still for about 20, 30 minutes,” Meng says. “And some people, if they just have a lot of disabilities and they have trouble doing that, it won’t be a very comfortable experience for them.” One other instance where caution may be advised: “Some people are on blood thinners like warfarin or other anticoagulants, and you do have to be careful with acupuncture,” Meng says. "Because even though the needles are very, very thin, there’s always an increased risk of bleeding when you’re on those type of blood thinners.”

For those who are interested in trying acupuncture to treat arthritis pain, it’s important to seek out a licensed acupuncturist, who is board certified, says Brian Jackson, an acupuncturist in the orthopaedics department at the University of Maryland School of Medicine. Experts also advise not only considering the professional’s education not only in acupuncture generally, but inquiring about the practitioner’s experience treating arthritis pain and other chronic pain. “The majority of our patients are sort of neck and lower back pain patients; and we have pretty good success rates with treating those patients,” Jackson says.

A physician referral is a good place to start to find an acupuncturist – but often that’s not possible (your physician may not have any suggestions on this).

National Certification Commission for Acupuncture and Oriental Medicine, or the NCCAOM, provides an online directory to find a certified acupuncturist in your area. As the non-profit’s website notes, “NCCAOM is the only national organization that validates entry-level competency in the practice of acupuncture and Oriental medicine (AOM) through professional certification.”

Many states require this certification, which involves taking an exam to demonstrate competency in acupuncture, to get licensed. “If you have an acupuncturist working within a hospital system oftentimes we mandate the NCCAOM certification in order to go through our credentialing process,” Starkey says. “So it’s a sure bet that if they have the certification, they’ve at least met minimum standard requirements as far as education and clinical training.”

Besides evaluating the practitioner, you’ll also want to check on insurance coverage. “Acupuncture’s not covered by Medicare, and it’s covered by some commercial insurances, but certainly not all of them,” Meng notes. Starkey adds that increasingly more private insurers are covering it. “I definitely encourage patients to reach out to their insurance company,” she says.

Besides checking on insurance coverage, you’ll want to talk with the acupuncturist about what to expect from treatments, as well. “I would definitely ask the acupuncturist – whoever you see – what the expectation is for the number of treatments and when you should expect a response. It shouldn’t just be endless treatment with no goal in sight,” Meng says. “I use three for my number of how many I’ll try before saying it’s a negative or positive trial. But depending on the person you see, that may vary.” And if you don’t see results with one acupuncturist or one type of acupuncture, that doesn’t mean you won’t – or can’t – from another, say practitioners; so it’s worth exploring your options.

Ultimately, the point is do your due diligence to address arthritis pain, experts say, so that you’re able to find some relief, whether that ultimately means trying – or sticking with – acupuncture or not.

https://health.usnews.com/health-care/patient-advice/articles/2019-03-05/should-i-try-acupuncture-for-arthritis