Moxibustion May Alleviate Arthritis Knee Pain

Jennifer Garcia

July 14, 2014

The practice of moxibustion, a therapy used in traditional Chinese medicine, may safely relieve pain and improve function for up to 18 weeks among patients with osteoarthritis of the knee, according to a new study published online June 24 in Arthritis Research and Therapy.

The randomized, double-blinded, placebo-controlled study enrolled 110 patients who had knee osteoarthritis diagnosed according to American College of Rheumatology criteria and who had a pain score of at least 3 out of 10 during the majority of the previous month, based on a 10-point visual analog scale. Patients with previous experience with moxibustion or those who had used intra-articular or topical arthritis therapy in the preceding 6 months were excluded.

Patients were randomly assigned to receive either active moxibustion therapy (n = 55) or a sham moxibustion treatment (n = 55) 3 times a week for 6 weeks. Therapy was performed at acupoint Dubi (ST 35), estra-point Neixiyan (EX-LE 4), and an Ashi (tender) point. Practitioners were acupuncturists with at least 5 years of acupuncture and moxibustion training. Response to therapy was assessed using the Western Ontario and McMaster University Osteoarthritis Scale (WOMAC VA 3.1). Patients were evaluated at the end of therapy and at 3, 12, and 24 weeks after therapy.

The researchers, led by Ling Zhao, MD, from Shanghai University of Traditional Chinese Medicine, China, noted greater improvements in WOMAC pain score among patients in the active treatment group at weeks 3 (P = .012), 6 (P < .001), 12 (P = .002), and 24 (P = .002) when compared with the scores for the control group. Physical function scores were also improved among the active treatment group at weeks 3 (P = .002), 6 (P = .015), and 12 (P < .001). The effect of therapy on physical function, however, appeared to have waned by week 24 compared with in the placebo group (P = .058). No adverse effects were reported in either group.

The authors note that the mechanism of action of moxibustion therapy is still not well understood but is thought to be similar to that of acupuncture therapy.

"The findings of the present trial show that moxibustion, like acupuncture, can be a useful adjunctive treatment for patients with [knee osteoarthritis]," the authors write.

In an interview with Medscape Medical News, independent commentator Jamie Starkey, LAc, lead acupuncturist at the Tanya I. Edwards Center for Integrative Medicine Wellness Institute at the Cleveland Clinic in Ohio, said: "This study showed clinical significance of the reduction in pain scores, as well as statistical significance with a moderate effect size."

Given the potential subjective nature of endpoint assessments, however, Starkey pointed out that "it would be beneficial to know if there were any objective measurements of change pre- and posttreatment, such as changes in inflammation. Also, moxibustion was used as an adjunct treatment, and it was unclear what conventional medications, if any, were being used by the subjects."

"It will take data from many more well-designed, randomized, controlled studies" before moxibustion becomes part of the routine management of patients with knee osteoarthritis, Starkey noted. "With that being said, however," she concluded, "I do feel this study is another step in the forward direction, providing supportive data of this noninvasive therapy's effectiveness in providing subjective pain relief and improved physical function."

Funding for this study was provided by the National Basic Research Program of China, the Key Program of the State Administration of TCM of China, the Shanghai Municipal Science Foundation, and the 2014 Innovation Program of the Shanghai Municipal First-Class Field of Traditional Chinese Medicine of Shanghai. The authors and independent commentator have disclosed no relevant financial relationships.

Arthritis Res Ther. Published online June 24 2014. Full text

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