Integrating acupuncture with exercise-based physical therapy for knee osteoarthritis: a randomized controlled trial.

BACKGROUND: Knee osteoarthritis is a chronic disease associated with significant morbidity and economic cost. The efficacy of acupuncture in addition to traditional physical therapy has received little study. OBJECTIVE: The objective of this study was to compare the efficacy and safety of integrating a standardized true acupuncture protocol versus nonpenetrating acupuncture into exercise-based physical therapy (EPT). METHODS: This was a randomized, double-blind, controlled trial at 3 physical therapy centers in Philadelphia, PA. We studied 214 patients (66% African Americans) with at least 6 months of chronic knee pain and x-ray-confirmed Kellgren scores of 2 or 3. Patients received 12 sessions of acupuncture directly following EPT over 6 to 12 weeks. Acupuncture was performed at the same 9 points dictated by the traditional Chinese "Bi" syndrome approach to knee pain, using either standard needles or Streitberger non-skin-puncturing needles. The primary outcome was the proportion of patients with at least a 36% improvement in Western Ontario and McMaster Universities Osteoarthritis Index score at 12 weeks. RESULTS: Both treatment groups showed improvement from combined therapy with no difference between true (31.6%) and nonpenetrating acupuncture (30.3%) in Western Ontario and McMaster Universities Osteoarthritis Index response rate (P = 0.5) or report of minor adverse events. A multivariable logistic regression prediction model identified an association between a positive expectation of relief from acupuncture and reported improvement. No differences were noted by race, sex, or age. CONCLUSIONS: Puncturing acupuncture needles did not perform any better than nonpuncturing needles integrated with EPT. Whether EPT, acupuncture, or other factors accounted for any improvement noted in both groups could not be determined in this study. Expectation for relief was a predictor of reported benefit.

Usefulness of the opioid risk tool to predict aberrant drug-related behavior in patients receiving opioids for the treatment of chronic pain.

OBJECTIVE: The purpose of this study was to determine if the opioid risk tool (ORT) was clinically useful in guiding physician decision making during chronic opioid therapy and to determine whether there were differences between the patient-completed and physician-completed ORT. DESIGN: Retrospective review of prospectively collected data. SETTING: A single-center tertiary care outpatient pain management center. PATIENTS, PARTICIPANTS: One-hundred twenty-five patients who received chronic opioids as part of their pain therapy. INTERVENTIONS: Patients receiving care were asked to complete the ORT as part of their initial evaluation. In addition, as part of this study, a pain physician reviewed the information available at the time of the initial evaluation and completed the ORT. Medical records were reviewed for evidence of moderate-to-severe aberrant drug-related behavior (ADRB), according to specified criteria. MAIN OUTCOME MEASURES: Patient-completed and physician-completed ORT and presence or absence of moderate to severe ADRB. RESULTS: Of the 125 patients included in this study, physician-completed ORT was available for 125 patients, and a patient-completed ORT was available on 87 of these patients. There was good correlation between the patient-completed and physician-completed ORT (correlation coefficient = 0.61). There were 112 observations of ADRB in 53 of 125 patients (42.4 percent) during the observation period of an average of 7.8 months (range 2-17 months). Of these 53 patients, 32 (60.4 percent) were identified by urine drug screen (UDS) alone, 7 (13.2 percent) were identified by physician observation alone, and 14 (26.4 percent) were identified by both UDS and physician observation. Based on the physician-completed ORT, 41 of 106 (38.7 percent) low risk patients had ADRB, compared to 8 of 14 (57.1 percent) moderate risk, and 4 of 5 (80 percent) high risk patients. CONCLUSIONS: Neither the patient-completed nor the physician-completed ORT was strongly predictive of moderate-to-severe ADRB in patients receiving chronic opioid therapy for the treatment of noncancer pain in our pain center.

Acupuncture for nonpalliative radiation therapy-related fatigue: feasibility study.

The purpose of this study was to determine the feasibility of an acupuncture clinical trial to prevent radiation therapy (RT)-induced fatigue. We conducted a cross-sectional survey study and a single-arm acupuncture clinical trial among patients undergoing RT. Patients with a Karnofsky score of less than 60, severe anemia, or substantial psychological diagnoses were excluded. Patients received up to 12 treatments of acupuncture over the entire course of their RT. The Lee Fatigue Scale (LFS) was administered at baseline, in the middle of RT, and at the end of RT, along with the Patient Global Impression of Change (PGIC). Among the 48 of 53 (91% response rate) survey participants, 20 (42%) reported that they would participate if the study were available, 13 (27%) would not participate, and 15 (31%) were unsure. Among the 16 trial participants, average fatigue and energy domains of the LFS remained stable during and after RT, without any expected statistical decline owing to RT. Based on the PGIC at the end of RT, 2 subjects (13%) reported their fatigue as worse, 8 (50%) as stable, and 6 (37%) as better. Acupuncture has the potential to prevent RT-related fatigue, which will need to be confirmed by conducting a randomized controlled trial.