Combined effect of laser acupuncture and electroacupuncture in knee osteoarthritis patients

Abstract Background: Knee osteoarthritis (KOA) is a common degenerative joint disorder that affects 250 million people globally. KOA can lead to disability and is often associated with cardiovascular disease, poor quality of life, and mortality. The most common treatment for KOA is non-steroidal anti-inflammatory drug administration. However, the analgesic effect is limited and often accompanied by multiple side effects. Hence, many KOA patients opt for complementary and alternative medicine. Acupuncture is one of the most popular complementary treatments with great analgesic effect and minimal side effect. Electroacupuncture (EA) and laser acupuncture (LA) have been known to reduce pain in KOA patients. However, to date, no study has assessed the benefits of combining these two therapies. Methods: Fifty participants diagnosed with KOA, aged 50 years or older, and with consistent knee pain for more than 3 months were recruited and randomly assigned to the treatment group (EA plus LA) or control group (EA plus sham LA without laser output). All subjects in the treatment group will undergo a combined EA and LA treatment thrice a week for 4 weeks. The acupuncture will be performed on GB33, GB34, SP9, SP10, and ST36 sites. The treatment group will receive acupuncture with a transcutaneous electrical nerve stimulator at GB33, GB34, SP9, and SP10 sites and with LA at EX-LE5, ST35, and BL40 sites. The subjects in the control group will undergo the same treatment modality as the treatment group, except these subjects will not be exposed to laser output. Outcome measurements will include visual analog scale, Western Ontario McMaster Universities Osteoarthritis Index, Knee injury and osteoarthritis outcome, body composition analysis, knee range of motion, quadriceps muscle stiffness, one-leg standing with eyes open test, and the 30-s chair stand test before and after 4 weeks of intervention. Objectives: This protocol aims to investigate the combined effect of EA and LA in KOA patients.

[1]  Raveendhara R. Bannuru,et al.  Duration of Symptom Relief and Early Trajectory of Adverse Events for Oral Nonsteroidal Antiinflammatory Drugs in Knee Osteoarthritis: A Systematic Review and Meta‐Analysis , 2020, Arthritis care & research.

[2]  J. Joensen,et al.  Efficacy of low-level laser therapy on pain and disability in knee osteoarthritis: systematic review and meta-analysis of randomised placebo-controlled trials , 2019, BMJ Open.

[3]  L. Callahan,et al.  Knee and hip osteoarthritis as predictors of premature death: a review of the evidence. , 2019, Clinical and experimental rheumatology.

[4]  Y. Hsiao,et al.  Immediate responses of multi‐focal low level laser therapy on quadriceps in knee osteoarthritis patients , 2019, The Kaohsiung journal of medical sciences.

[5]  J H Abbott,et al.  OARSI guidelines for the non-surgical management of knee, hip, and polyarticular osteoarthritis. , 2019, Osteoarthritis and cartilage.

[6]  Won Kim,et al.  Association between metabolic syndrome and knee osteoarthritis: A cross-sectional nationwide survey study. , 2019, Journal of rehabilitation medicine.

[7]  Juan Yang,et al.  Laser Acupuncture: A Concise Review. , 2019, Medical acupuncture.

[8]  Man Li,et al.  Effects of intensity of electroacupuncture on chronic pain in patients with knee osteoarthritis: a randomized controlled trial , 2019, Arthritis Research & Therapy.

[9]  S. Jalaie,et al.  Effects of Low-Level Laser Versus Laser Acupuncture in Patients With Knee Osteoarthritis: A Randomized Controlled Trial , 2019, Journal of Modern Rehabilitation.

[10]  D. Felson,et al.  Mechanisms of Osteoarthritis (OA) Pain , 2018, Current Osteoporosis Reports.

[11]  Fu-Huang Lin,et al.  The increase in total knee replacement surgery in Taiwan , 2018, Medicine.

[12]  J. Duarte,et al.  Non-pharmacological and non-surgical interventions to manage patients with knee osteoarthritis: An umbrella review. , 2018, Acta reumatologica portuguesa.

[13]  R. Helme,et al.  Effects of Electroacupuncture on Opioid Consumption in Patients with Chronic Musculoskeletal Pain: A Multicenter Randomized Controlled Trial , 2018, Pain medicine.

[14]  E. Elghoroury,et al.  Evaluation of serum beta-endorphin and substance P in knee osteoarthritis patients treated by laser acupuncture , 2018, Journal of complementary & integrative medicine.

[15]  Artigo de Revisão.  Non-pharmacological and non-surgical interventions to manage patients with knee osteoarthritis: an umbrella review , 2018 .

[16]  A. Coutaux.  Non-pharmacological treatments for pain relief: TENS and acupuncture. , 2017, Joint, bone, spine : revue du rhumatisme.

[17]  Joseph R Yancey,et al.  Topical NSAIDs for Chronic Musculoskeletal Pain in Adults. , 2017, American family physician.

[18]  M. Moradi-Joo,et al.  Safety and Effectiveness of Low-Level Laser Therapy in Patients With Knee Osteoarthritis: A Systematic Review and Meta-analysis. , 2017, Journal of lasers in medical sciences.

[19]  A. Mucelli,et al.  Electro-Acupuncture is Beneficial for Knee Osteoarthritis: The Evidence from Meta-Analysis of Randomized Controlled Trials. , 2017, The American journal of Chinese medicine.

[20]  L. Nartey,et al.  Effectiveness of non-steroidal anti-inflammatory drugs for the treatment of pain in knee and hip osteoarthritis: a network meta-analysis , 2017, The Lancet.

[21]  Sung-Soo Kim,et al.  Effects of Electroacupuncture for Knee Osteoarthritis: A Systematic Review and Meta-Analysis , 2016, Evidence-based complementary and alternative medicine : eCAM.

[22]  N. Beyer,et al.  The impact of self-efficacy on physical activity maintenance in patients with hip osteoarthritis – a mixed methods study , 2016, Disability and rehabilitation.

[23]  F. Rannou,et al.  Risk factors and burden of osteoarthritis. , 2016, Annals of physical and rehabilitation medicine.

[24]  C. Juhl,et al.  Arthroscopic surgery for degenerative knee: systematic review and meta-analysis of benefits and harms , 2015, BMJ : British Medical Journal.

[25]  Michael R Hamblin,et al.  The Use of Low Level Laser Therapy (LLLT) For Musculoskeletal Pain. , 2015, MOJ orthopedics & rheumatology.

[26]  T. Birmingham,et al.  Valgus Bracing for Knee Osteoarthritis: A Meta‐Analysis of Randomized Trials , 2015, Arthritis care & research.

[27]  N. Kamide,et al.  The Reference Values for the Chair Stand Test in Healthy Japanese Older People: Determination by Meta-analysis , 2014, Journal of physical therapy science.

[28]  W. Wang,et al.  Efficacy of low-level laser therapy applied at acupuncture points in knee osteoarthritis: a randomised double-blind comparative trial. , 2014, Physiotherapy.

[29]  C. Juhl,et al.  Impact of Exercise Type and Dose on Pain and Disability in Knee Osteoarthritis: A Systematic Review and Meta‐Regression Analysis of Randomized Controlled Trials , 2014, Arthritis & rheumatology.

[30]  L. Lao,et al.  Mechanisms of Acupuncture–Electroacupuncture on Persistent Pain , 2014, Anesthesiology.

[31]  A. Alghadir,et al.  Effect of low-level laser therapy in patients with chronic knee osteoarthritis: a single-blinded randomized clinical study , 2014, Lasers in Medical Science.

[32]  K. Kerschan-Schindl,et al.  Osteoarthritis: physical medicine and rehabilitation—nonpharmacological management , 2013, Wiener Medizinische Wochenschrift.

[33]  Yu-Chiang Hung,et al.  Explore Laser Acupuncture’s Role , 2013 .

[34]  Tao Li,et al.  [Efficacy observation on knee osteoarthritis treated with electroacupuncture and its influence on articular cartilage with T2 mapping]. , 2013, Zhongguo zhen jiu = Chinese acupuncture & moxibustion.

[35]  D. Vasilakos,et al.  Acupuncture as an adjunctive therapy to pharmacological treatment in patients with chronic pain due to osteoarthritis of the knee: A 3-armed, randomized, placebo-controlled trial , 2012, PAIN®.

[36]  J Natour,et al.  Impact of cane use on pain, function, general health and energy expenditure during gait in patients with knee osteoarthritis: a randomised controlled trial , 2011, Annals of the rheumatic diseases.

[37]  N. Taylor,et al.  Pre-operative interventions (non-surgical and non-pharmacological) for patients with hip or knee osteoarthritis awaiting joint replacement surgery--a systematic review and meta-analysis. , 2011, Osteoarthritis and cartilage.

[38]  B. Heidari.  Knee osteoarthritis diagnosis, treatment and associated factors of progression: part II. , 2011, Caspian journal of internal medicine.

[39]  D. Padua,et al.  Reliability, validity, and precision of a handheld myometer for assessing in vivo muscle stiffness. , 2011, Journal of sport rehabilitation.

[40]  T. Coughlin.  Knee osteoarthritis. , 2011, American family physician.

[41]  Dexin Zeng,et al.  The effect of low-level laser to apoptosis of chondrocyte and caspases expression, including caspase-8 and caspase-3 in rabbit surgery-induced model of knee osteoarthritis , 2012, Rheumatology International.

[42]  Sabina Lim.  WHO Standard Acupuncture Point Locations , 2009, Evidence-based complementary and alternative medicine : eCAM.

[43]  M. Aslam,et al.  Clinical and endocrinological changes after electro-acupuncture treatment in patients with osteoarthritis of the knee , 2009, PAIN®.

[44]  Shu-yun Jiang,et al.  Clinical efficacy evaluation on electroacupuncture for osteoarthritis and observation on biomechanical indexes , 2009 .

[45]  Li-Hui Yu,et al.  Normative Physical Fitness Scores for Community-Dwelling Older Adults , 2009, The journal of nursing research : JNR.

[46]  S. McDonough,et al.  Clinical effectiveness of laser acupuncture: a systematic review. , 2008, Journal of acupuncture and meridian studies.

[47]  T. Vahlberg,et al.  Effects of risk-based multifactorial fall prevention on health-related quality of life among the community-dwelling aged: a randomized controlled trial , 2007, Health and quality of life outcomes.

[48]  E. Roos,et al.  Cross-cultural adaptation and validation of Singapore English and Chinese versions of the Knee injury and Osteoarthritis Outcome Score (KOOS) in Asians with knee osteoarthritis in Singapore. , 2006, Osteoarthritis and cartilage.

[49]  C. Bombardier,et al.  Evaluation of clinically relevant changes in patient reported outcomes in knee and hip osteoarthritis: the minimal clinically important improvement , 2004, Annals of the rheumatic diseases.

[50]  Patricia Langenberg,et al.  Effectiveness of Acupuncture as Adjunctive Therapy in Osteoarthritis of the Knee , 2004, Annals of Internal Medicine.

[51]  F. Taşcioğlu,et al.  Low power laser treatment in patients with knee osteoarthritis. , 2004, Swiss medical weekly.

[52]  R. Jubb,et al.  The Effect of Acupuncture on the Symptoms of Knee Osteoarthritis - An Open Randomised Controlled Study , 2004, Acupuncture in medicine : journal of the British Medical Acupuncture Society.

[53]  C. Jinks,et al.  A brief screening tool for knee pain in primary care (KNEST). 2. Results from a survey in the general population aged 50 and over. , 2004, Rheumatology.

[54]  E. Mills,et al.  Adverse effects of acupuncture. Which are clinically significant? , 2003, Canadian family physician Medecin de famille canadien.

[55]  B. Danneskiold-Samsøe,et al.  Low power Ga-Al-As laser treatment of painful osteoarthritis of the knee. A double-blind placebo-controlled study. , 1994, Scandinavian journal of rehabilitation medicine.

[56]  N. Bellamy,et al.  Osteoarthritis antirheumatic drug trials. III. Setting the delta for clinical trials--results of a consensus development (Delphi) exercise. , 1992, The Journal of rheumatology.