What are the Benefits of Acupuncture Therapy in the Treatment of Osteoarthritis?

In Western Medicine, osteoarthritis is a degenerative disease where cartilage in the joint gradually wears away. It may be caused by excess stress on the joint; such as from repeated injury, deformity, or if a person is overweight. It most often affects middle-aged and older people. A young person who develops osteoarthritis may have an inherited form of the disease or may have experienced continuous irritation from an unrepaired torn meniscus or other injury. Most often osteoarthritis is treated with analgesics (pain-reducing medicines), such as aspirin or acetaminophen (Tylenol): nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Motrin, Nuprin, Advil); and exercises to restore joint movement and strengthen the knee. Losing excess weight can also help people with osteoarthritis.

In traditional Chinese acupuncture medicine, osteoarthritis is a subgroup of Bi-syndrome (Tukmachi, 1999 which is a classic example of how a disease is caused by the invasion of external pathogenic factors such as Wind, Cold, or Dampness. According to these external pathogenic factors, the following four patterns of arthritis are differentiated to address these patterns:

1.       Wind Pattern. Exposure to wind is an important cause of the Wind pattern of arthritis. The Wind pattern of arthritis is characterized by joint soreness and pain. The pain moves from joint to joint like wind. Movement of joints is limited. Aversion to wind and fever is experienced. Thin and white tongue coating and a floating pulse is read by Chinese medicine practitioners.

2.       Cold Pattern. The Cold pattern of arthritis is characterized by a severe pain in a joint or muscle. The pain has a fixed location. The pain is reduced by warmth and increased by cold. Movement of joints is limited. Thin and white tongue coating and a wiry and tight pulse are read.

3.       Damp Pattern. The Damp pattern of arthritis is characterized by pain, soreness, and swelling in muscles and joints with a feeling of heaviness and numbness of the limbs. The pain has a fixed location and is aggravated by damp weather. White and sticky tongue coating and soggy and slow pulse are read.

4.       Heat Pattern. The Heat pattern of arthritis is originated from any of the above three patterns. It is characterized by a severe pain and hot-red-swollen joints. The pain is reduced with cold. Aversion to wind, fever, thirsty and anxiety might be experienced. Yellow and dry tongue coating and slippery and rapid pulse are read.

One of the advantages of acupuncture is that the incidence of adverse effects is substantially lower than that of many drugs or other accepted medical procedures used for treatment of Osteoarthritis. From the perspective of acupuncturists and patients, the results of treatment have often been good. Our clinical research trials at the Department of Rheumatology, Birmingham University have provide an opportunity to demonstrate the clinical benefit (and economic saving) of acupuncture for patients with osteoarthritis (Tukmachi, E.S.A., Dempsey, E., Jubb, R.W. (2004); Tukmachi, E.S.A. (2000); Tukmachi, E.S.A. (1990); Jubb RW, Tukmachi ES, Jones PW, Dempsey E, Waterhouse L, Brailsford S. (2008)). Considerable evidence supports the claim that opioid peptides are released during acupuncture and that the analgesic effects of acupuncture are at least partially explained by their actions. Stimulation by acupuncture may also activate the hypothalamus and the pituitary gland, resulting in a broad spectrum of systemic effects. Alteration in the secretion of neurotransmitters and neurohormones and changes in the regulation of blood flow, both centrally and peripherally, have been documented.

In Western acupuncture, treatment of osteoarthritis is usually directed specifically at the trigger points, which are found in and around the joint, including ligaments, tendons, articular fat pads and muscles. Deactivation of these trigger points can be achieved by the acupuncture technique of dry needle stimulation. While in Traditional Chinese Acupuncture, osteoarthritis is a subgroup of Bi-syndrom (Tukmachi, 1999). Bi-syndrome is a classical example of how a disease is caused by the invasion of external pathogenic factors such as Wind, Cold, or Dampness. According to these external pathogenic factors, the following four patterns of arthritis are differentiated and the leading herbs to address these patterns are discussed.

It is believed that the meridians (energy pathways) are blocked with arthritis, or generally Bi-syndrome indicating pain, soreness or numbness of muscles, tendons and joints in traditional Chinese medicine. As a result, the Chi and Blood in the meridians are obstructed. Acupuncture helps open the blockage, balance the energy, and harmonize the Chi and Blood.

Acupuncture as a therapy is widely practiced in the United Kingdom., Promising results have emerged, for example, showing efficacy of acupuncture in non-painful conditions (Tukmachi, 199) as well as painful conditions such osteoarthritis (Tukmachi, 1991, 1999). Acupuncture may be useful as an adjunct treatment or an acceptable alternative or be included in a comprehensive management program. The success of acupuncture treatment in osteoarthritis depends on the following factors:

1.       Number of acupuncture treatment sessions.

2.       Mode of stimulation (electrical, manual or both).

3.       Duration and frequency of stimulation.

4.       Whether "Teh-chi" sensation (e.g. numbness, tingling, soreness...etc) were sought.

5.       Point classification (the classical Chinese points, motor points, trigger points, points within the dermatome...etc).

6.       Diagnosis (Western and, if appropriate, traditional Chinese   acupuncture diagnosis).

Further research is likely to uncover additional areas where acupuncture interventions will be useful. There is sufficient evidence of acupuncture’s value to expand its use into conventional medicine and to encourage further studies of its physiology and clinical value.

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