Acupuncture for hip arthritis

A: As you might imagine there is little or no research into the use of acupuncture for bursitis in the hip. This is mainly to do with the fact that as a symptom it can be caused by any number of disturbances in and around the hip joint itself, and western research is predicated on reducing the variables to the minimum possible. Some of the causes are more intractable than others, and would make comparisons difficult.

The same applies to Chinese medicine, of course, but we live with a system of medicine that embraces multiple causes and dynamic balance, so it is less of a problem for us. Clearly, though, the same overall conditions apply; if the bursitis is caused by a systemic condition, like gout, then it is going to be more difficult to treat. However, the same general rules apply about rest until almost better apply.

From a Chinese medicine perspective, however, accumulations of fluid within a capsule are usually interpreted as a breakdown in the flow of fluids through blockage or through a change in the consistency of the fluid itself. Since this is usually indicative of a breakdown in the flow of energy, called ‘qi’, on which the system is based, there are a number of treatments, especially local ones, which can help to improve the flow and remove/relieve the swelling. The key issue, however, is that Chinese medicine will never look at a symptom in isolation, but always consider it within an understanding of the way that the whole body is functioning. Without this, in many cases the treatment will only have a short effect. It is a matter of not just treating the condition but treating the underlying causes of the condition. This will involve taking into account the conventional medical assessment of what is happening but focus more on the way that the whole body functions. Many people have secondary problems which they accept as normal but which greatly enrich a Chinese medicine understanding of what is going on. There is such a huge variation in presentations, though, that the best advice we can give you is to visit a BAcC member local to you for an informal assessment of what may be possible. Most of our colleagues are more than happy to offer a short amount of time to assess whether treatment would be effective, and if they believe not, to offer alternative recommendations for other treatments.

One final word: we never use the word ‘cure’, partly because it is not clear what ‘cure’ would mean i n this context but mainly because we believe that we are helping a system to restore its own flow and balance. We simply put needles in; it’s the patient who does all the hard work afterwards!

Contents

Physio Works – Physiotherapy Brisbane

Article by J. Miller, Z. Russell

What is Trochanteric Bursitis?

The Most Common Hip Bursitis

Trochanteric bursitis is the most common bursitis of the hip. It is also a common cause of Greater Trochanteric Pain Syndrome.

Trochanteric bursitis is inflammation of the bursa (a small, cushioning sac located where tendons pass over areas of bone around the joints), which lies over the prominent bone on the side of your hip (femur).

The superficial trochanteric bursa is located over the greater trochanter. This is the most commonly inflamed bursa. A deep trochanteric bursa lies deeper and can become inflamed in more severe cases.

What is Bursitis?

What Causes Trochanteric Bursitis?

The trochanteric bursa is normally caused by repeated compression of the bursa resulting in inflammation and pain. It is usually associated with weakness of the gluteal muscles, particularly gluteus medius, that results in a Trendelenburg gait pattern that is a sign of hip muscle weakness. It can be related to a previous back or hip injury. Researchers have found that gluteal weakness is a side effect of poorly rehabilitated low back pain or hip pathologies.

The good news is that muscle weakness and Trendelenburg gait can be reversed by an appropriately progressed exercise protocol. The exercises prescribed should be focused on retraining your specifically weak muscles. This is important since different gluteal and hip rotator muscles are strengthened by different exercises. For more specific advice regarding your hip muscle weakness, please seek the advice of your physiotherapist, who has a special interest in gluteal and hip pathologies.

While gluteal muscle weakness does become more prevalent as we age, we certainly also see weakness in the younger active population. In these cases muscle fatiguing activities such as running (with poor muscles control or technique), bushwalking into fatigue, or cycling, especially when the bicycle seat is too high can induce trochanteric bursitis or be related to a gluteal tendinopathy.

Occasionally, acute onset trochanteric bursitis can occur following a fall or a sport-related impact contusion to the hip.

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How is Trochanteric Bursitis Diagnosed?

Your physiotherapist or doctor can normally diagnose trochanteric bursitis in the clinic. This will be based upon an assessment of your history and a physical examination of your hip, pelvis and back. A hallmark sign is if you feel tenderness over the bursa or greater trochanter (hip bone) when pressure is applied.

Diagnosis can also be confirmed by medical imaging techniques that include ultrasound scan & MRI.

What are Trochanteric Bursitis Symptoms?

One or more of the following symptoms may be experienced:

  • Pain and swelling occurring over the side of the hip bone (greater trochanter)
  • Referred pain that travels down the outside thigh and may continue down to the knee
  • Pain when sleeping on your side; especially the affected hip
  • Pain upon getting up from a deep chair or after prolonged sitting (eg. in a car)
  • Pain when climbing stairs
  • Pain in sitting with the legs crossed
  • Increased pain when running, walking, cycling or standing for long periods of time

What is the Best Treatment for Trochanteric Bursitis?

The best treatment for trochanteric bursitis involves:

  1. Early Pain Relief & Anti-inflammatory Treatment
  2. Corrective Exercises to address specific muscle weakness
  3. Preventative Exercises to reduce the risk of future bursa irritation

Ice

Bursitis is an inflammed bursa. Application of ice packs a few times per day is highly recommended to reduce your pain and swelling. Ice is a natural anti-inflammatory that is more likely to assist bursitis than heat packs.

Anti-inflammatory Medications

NSAIDs or anti-inflammatory drugs (i.e. ibuprofen) may assist but do appear to be less successful for trochanteric bursitis. Natural anti-inflammatories such as arnica are also trialed by many patients. Use of these medications should be discussed with your doctor to avoid any side effects.

Corticosteroid Injections

Combined injection of a corticosteroid plus a local anaesthetic into the bursa may be recommended to reduce your bursa inflammation. It is preferable to have this injection using ultrasound guidance. The local anaesthetic will provide immediate short-term relief (a day or two). The cortisone is slower acting and will take a few days up to a week to act on inflammation reduction.

How Can You Prevent Trochanteric Bursitis?

Muscle weakness, muscle fatigue or gluteal tendinopathy are thought to be the major causes of trochanteric bursitis. Addressing your muscle strength and endurance is recommended to avoid a recurrence. Wearing adequate footwear which supports any biomechanical imbalances in your feet is also a key preventative measure.

Successful weight management minimises excess stress on the hip joints, which can alleviate pressure on the bursa. If you need advice regarding your weight-loss please discuss with your doctor or dietitian.

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Trochanteric Bursitis Treatment

PHASE I – Pain Relief & Protection

Managing your pain. Pain is the main reason that you seek treatment for trochanteric bursitis. In truth, it was actually the final symptom that you developed and should be the first symptom to improve.

Managing your inflammation. Bursa inflammation it best eased via ice therapy, cortisone injections, supportive taping techniques or exercises that encourage your muscles to decompress the bursa.

Your physiotherapist may use an array of treatment tools to reduce your pain and inflammation. These can include ice, electrotherapy, acupuncture, de-loading taping techniques, soft tissue massage and temporary use of a mobility aid (eg cane or crutch) to off-load the affected side.

PHASE II – Restoring Normal ROM, Strength

As your pain and inflammation settles, your physiotherapist will turn their attention to restoring your normal hip joint range of motion, muscle length and resting tension, muscle strength and endurance, proprioception, balance and gait (walking pattern).

Hip researchers have discovered the importance of your hip muscle recruitment patterns with a normal order of: deep, then intermediate and finally superficial muscle firing patterns in normal pain-free hips. Your physiotherapist will assess your muscle recruitment pattern and prescribe the best exercises for you specific to your needs.

PhysioWorks has developed a “Hip Core Stabilisation Program” to assist their patients to regain normal hip muscle control. Please ask your physio for their advice.

PHASE III – Restoring Full Function

The final stage of your rehabilitation is aimed at returning you to your desired activities. Everyone has different demands for their hips that will determine what specific treatment goals you need to achieve. For some people, it simply be to walk around the block. Others may wish to run a marathon.

Your physiotherapist will tailor your hip rehabilitation to help you achieve your own functional goals.

PHASE IV – Preventing a Recurrence

Trochanteric bursitis does have a tendency to return. The main reason it is thought to recur is due to insufficient rehabilitation.

In addition to your muscle control, your physiotherapist will assess your hip biomechanics and start correcting any defects. It may be as simple as providing you with gluteal or deep hip rotator exercises to address any biomechanical faults in your leg. Your physiotherapist will guide you based upon your assessment.

Fine-tuning your hip stability and function by addressing any deficits in core strength and balance, learning self-management techniques and achieving the ultimate goal of safely returning to your previous sporting or leisure activities.

Trochanteric Bursitis Surgery

Surgery is not a common path. However, in persistent cases, removal of the bursa (bursectomy), can be performed.

What Results Can You Expect for Trochanteric Bursitis?

While some people can respond quickly to physiotherapy treatment within a few weeks, more chronic cases where gluteal tendinopathy exists in the gluteal muscle group under the bursa can require a few weeks and sometimes months to achieve recovery.

Trochanteric bursitis is successfully managed in the vast majority over a period of approximately six weeks. It is important to not stop your rehabilitation exercises as soon as you pain abates. You may be recommended some prevention exercises to perform as a part of your weekly health and wellbeing program.

Excellent hip muscle control is your best rehabilitation and prevention strategy. Please follow the advice of your physiotherapist or doctor.

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Common Trochanteric & Hip Bursitis Treatments

  • Early Injury Treatment
  • Avoid the HARM Factors
  • Soft Tissue Injury? What are the Healing Phases?
  • Acupuncture and Dry Needling
  • Core Exercises
  • Biomechanical Analysis
  • Balance Enhancement Exercises
  • Proprioception & Balance Exercises
  • Agility & Sport-Specific Exercises
  • Medications?
  • Real Time Ultrasound Physiotherapy
  • Soft Tissue Massage
  • Brace or Support
  • Bursitis Treatment
  • Dry Needling
  • Electrotherapy & Local Modalities
  • Kinesiology Tape
  • Prehabilitation
  • Strength Exercises
  • Stretching Exercises
  • Supportive Taping & Strapping
  • TENS Machine
  • Video Analysis
  • Yoga
  • Helpful Products for Trochanteric Bursitis

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    Related Injuries

    General Information

    • Hip Pain
    • Groin Pain

    Hip Joint Pain

    • Hip Arthritis – Osteoarthritis
    • Hip Labral Tear
    • Hip Pointer
    • Femoroacetabular Impingement – FAI
    • Perthes Disease
    • Slipped Femoral Capital Epiphysis
    • Stress Fracture
    • Avascular Necrosis of the Femoral Head

    Lateral Hip Pain

    • Gluteal Tendinopathy
    • Greater Trochanteric Pain Syndrome
    • Trochanteric Bursitis

    Adductor-related Groin Pain

    • Adductor Tendinopathy
    • Groin Strain

    Pubic-related Groin Pain

    • Osteitis Pubis

    Inguinal-related Groin Pain

    • Inguinal hernia
    • Sportsman’s hernia

    Iliopsoas-related Groin Pain

    • Hip Flexor Strain

    Other Muscle-related Pain

    • Piriformis Syndrome
    • Muscle Pain -Muscle Strain
    • Poor Hip Core
    • DOMS -Delayed Onset Muscle Soreness
    • Cramps
    • Core Stability Deficiency

    Systemic Diseases

    • Rheumatoid Arthritis
    • Fibromyalgia
    • Osteoporosis

    Referred Sources

    • Sacroiliac Joint Pain -SIJ
    • Sciatica
    • Lower Back Pain
    • Pinched Nerve

    Hip Surgery

    • Hip Replacement

    FAQs about Trochanteric Bursitis

  • Common Physiotherapy Treatment Techniques
  • What is Pain?
  • Physiotherapy & Exercise
  • When Should Diagnostic Tests Be Performed?
  • Can Kinesiology Taping Reduce Your Swelling and Bruising?
  • How Can You Prevent a Future Leg Injury?
  • How Much Treatment Will You Need?
  • Sports Injury? What to do? When?
  • What are the Common Massage Therapy Techniques?
  • What are the Early Warning Signs of an Injury?
  • What is a TENS Machine?
  • What is Chronic Pain?
  • What is Nerve Pain?
  • What is Sports Physiotherapy?
  • What’s the Benefit of Stretching Exercises?
  • When Can You Return to Sport?
  • Why Kinesiology Tape Helps Reduce Swelling and Bruising Quicker
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    Complementary and Alternative Medicine

    Treatment Options

    Resting and elevating the joint can help. A splint, sling, or other device can support the joint and keep it from moving. Applying ice or heat may help relieve pain and swelling. Once the joint is no longer painful, you can work to strengthen the muscles around the joint, which may help prevent further flare-ups.

    Drug Therapies

    • Nonsteroidal anti-inflammatory drugs (NSAIDs). To reduce pain and inflammation. Over-the-counter NSAIDs include ibuprofen (Motrin, Advil) and naproxen (Aleve). Prescription NSAIDs include diclofenac (Voltaren), ketoprofen (Orudis), and naproxen. Using NSAIDs over a long period of time can increase the risk of stomach bleeding and heart attack.
    • Corticosteroids. An injection into the bursa can reduce inflammation. Sometimes, oral corticosteroids are used for long-lasting inflammation. There are risks associated with corticosteroids. Speak to your doctor.

    Surgical and Other Procedures

    In rare cases, the bursa is surgically removed.

    Complementary and Alternative Therapies

    Alternative therapies may help reduce the pain and inflammation of bursitis.

    Nutrition and Supplements

    Eat whole grains, fruits, vegetables, and fatty fish to help reduce inflammation. Avoid processed foods and foods high in sugar and fat. The following supplements may help. Supplements may not be appropriate for all people and may have side effects and/or interact with medications. If you are pregnant or breastfeeding, talk to your physician before adding a supplement to your regimen.

    • Glucosamine sulfate. Glucosamine is a substance found in cartilage, the tissue that covers the ends of bones in a joint. Some evidence suggests it may help treat the pain of osteoarthritis. It may also help reduce inflammation in bursitis. Glucosamine increases the risk of bleeding. People who take blood-thinning medications, such as aspirin, clopidogrel (Plavix), or warfarin (Coumadin), should not take glucosamine. Glucosamine may increase cholesterol levels. Use special caution if you have a history of asthma or diabetes.
    • Omega-3 fatty acids , such as fish oil or flaxseed oil. Although evidence is mixed on whether fish oil helps reduce inflammation, it seems to reduce the amount of inflammatory chemicals your body makes over time. Omega-3 fatty acids can increase the risk of bleeding. People who take blood-thinning medications, such as aspirin, clopidogrel (Plavix), or warfarin (Coumadin), should ask their doctor before taking fish oil.
    • Vitamin C with flavonoids to help repair connective tissue (such as cartilage). Vitamin C supplements may interact with other medications, including chemotherapy drugs, estrogen, warfarin (Coumadin), and others.
    • Bromelain , an enzyme that comes from pineapples, reduces inflammation. Bromelain may increase the risk of bleeding, so people who take blood thinners should not take bromelain without first talking to their doctor. People with peptic ulcers should avoid bromelain. If taken with antibiotics, bromelain may increase the level of the antibiotic in the body, which could be dangerous. Turmeric is sometimes combined with bromelain because it makes the effects of bromelain stronger. Turmeric and bromelain together can also increase the risk of bleeding.

    Herbs

    The use of herbs is a time-honored approach to strengthening the body and treating disease. Herbs, however, can trigger side effects and can interact with other herbs, supplements, or medications. For these reasons, you should take herbs with care under the supervision of a health care provider.

    The herbs listed below may help reduce inflammation. They also can increase the risk of bleeding. People who take blood-thinning medications, such as aspirin, clopidogrel (Plavix), or warfarin (Coumadin), should ask their doctor before taking them.

    • Boswellia ( Boswellia serrate ).
    • Turmeric ( Curcuma longa ). Turmeric is sometimes combined with bromelain because it makes the effects of bromelain stronger.
    • White willow ( Salix alba ) acts similar to aspirin. It can be made into a tea by boiling 1/2 tsp. (2 grams) of bark in 8 ounces of water. Drink up to 5 cups per day. DO NOT take white willow if you are also taking aspirin or blood-thinning medications. Check with your doctor if you are allergic to aspirin or salicylates before taking white willow. DO NOT give white willow to children under the age of 18. Turmeric and white willow also can be used to reduce swelling.

    Homeopathy

    Although few studies have examined the effectiveness of specific homeopathic therapies, professional homeopaths may consider the following remedies for the treatment of bursitis based on their knowledge and experience. Before prescribing a remedy, homeopaths take into account a person’s constitutional type, includes your physical, emotional, and psychological makeup. An experienced homeopath assesses all of these factors when determining the most appropriate treatment for each individual.

    • Arnica gel . Applied topically (to the skin) as directed, gives excellent short-term pain relief.
    • Arnica . For bursitis occurring after an injury to the joint.
    • Ruta graveolons . For rheumatic pains in the joint.
    • Bellis perennis . For injury with a great deal of bruising.
    • Rhus toxicodendron . For pain that gets better with movement.

    Acupuncture

    Acupuncture can help reduce swelling and inflammation and relieve pain.

    Chiropractic

    Although no well-designed scientific studies have looked at whether chiropractic treatment helps bursitis, chiropractors often treat people with this condition. They report that some persons have less pain and increased range of motion. In addition to spine and joint manipulation, chiropractors are likely to use other treatments to treat bursitis, including ice massage and ultrasound therapy.

    Movement Therapy

    Exercising the muscles around your joints helps reduce pressure on the joint and bursa. Gentle yoga may help bursitis by increasing flexibility and reducing muscle tension. Other movement therapies, such as Pilates and Tai Chi, may also help improve muscle and ligament strength and reduce the tension caused by repetitive motions.

    Massage

    You should not use massage if your bursitis is caused by an infection. Otherwise, massage, especially myofascial release therapy, may help you relax and may reduce the discomfort from a sore joint.

    It’s been about 2,000 years in the making, but acupuncture has gained some mainstream acceptance as a medical modality. Research offers limited, but in some cases promising, evidence that acupuncture can help with arthritis symptoms.

    The theory of acupuncture goes something like this: An essential life energy called qi (pronounced “chee”) flows through the body along 20 invisible channels called meridians. When the flow of this energy is blocked or out of balance, illness or pain results. More than 2,000 acupuncture points connect to the meridians. Stimulating those points with needles, it is said, will correct the flow of qi and alleviate pain.

    How Acupuncture’s Affects Arthritis

    Western medicine doesn’t recognize the concepts of qi and meridians. However, scientific evidence suggests alternate explanations for why acupuncture might provide pain relief.

    “There’s a lot of research that says when we put an acupuncture needle into the body, a number of physiological mechanisms occurs,” says Brian Berman, MD, professor of family and community medicine and director of the Center for Integrative Medicine at the University of Maryland School of Medicine.

    A well-placed needle sets off a cascade of events, Dr. Berman explains, producing a signal that travels along the spinal cord to the brain, triggering a release of neurotransmitters called endorphins and enkephalins, which scientists believe reduce the sensation of pain. Research also shows that inserting an acupuncture needle induces the production of cortisol, a hormone that helps control inflammation. Acupuncture may stimulate activity of other pain-relieving chemicals in the body as well.

    But do all these biochemical changes relieve sore, stiff joints? A study by Dr. Berman and his colleagues found that after 26 weeks, patients receiving real acupuncture felt significantly less pain and functioned better (as measured by how far they could walk in six minutes) than their counterparts who received sham acupuncture.

    What the Research Shows

    Other studies haven’t been as positive, and acupuncture’s benefits have been hard to prove because high-quality studies on the subject of arthritis and acupuncture have been limited. Here’s a look at some of the recent research that has been done:

    • Osteoarthritis. Even though patients offer anecdotal evidence that acupuncture has helped them, most studies have found acupuncture offers minimal pain and stiffness relief for osteoarthritis (OA). A 2018 Cochrane review of six studies evaluating acupuncture for hip OA concluded acupuncture probably has little or no effect in reducing pain or improving function compared to sham acupuncture in people with hip osteoarthritis. One unblinded trial found that acupuncture as an addition to routine primary physician care was associated with reduced pain and improved function. However, these reported benefits are likely due at least partially to participants’ greater expectations that acupuncture can help.
    • Rheumatoid Arthritis. Recent research suggests acupuncture may hold a beneficial role in treatment for some people with rheumatoid arthritis (RA). A review of 43 studies, conducted between 1974 and 2018 and reported in Evidence-based Complementary and Alternative Medicine, concluded that “acupuncture alone or combined with other treatment modalities is beneficial to the clinical conditions of RA and can improve function and quality of life, and is worth trying.” The review cites several possible ways acupuncture effects RA, including its anti-inflammatory effect, antioxidative effect and regulation of immune system function. However, the review acknowledges that there is still inconsistency among trial findings and that further research is needed to evaluate the effects of acupuncture and how it works.
    • Fibromyalgia. In a 2014 review article in Journal of Traditional Chinese Medicine, researchers analyzed the results of nine studies on acupuncture for fibromyalgia. Though a few studies found acupuncture worked better than drugs to manage the condition, most of the studies weren’t well designed. The authors concluded there wasn’t enough evidence to prove acupuncture works better than placebo.

    Just a Placebo Effect? It May Not Matter

    Some experts question whether pain relief noted in the studies is real or the result of a placebo effect – patients feeling better simply as a result of having needles applied to their skin. In a 2012 meta-analysis of studies published in JAMA Internal Medicine, researchers found real acupuncture was more effective than placebo at treating chronic pain – but only slightly so; 50 percent of acupuncture patients said their pain improved by half or more compared to 42.5 percent of patients receiving placebo treatments.

    Other doctors say that even if acupuncture’s benefits are largely due to a placebo effect, it still could be worth trying. Growing research suggests that fake needles and other placebos may prevent pain signals from reaching the brain and promote other biological changes that could relieve symptoms of osteoarthritis and other conditions.

    “If I’m suffering chronic pain and someone offers me an intervention that will improve my symptoms, I’d be thinking, ‘Of course I want that,’” says Andrew L. Avins, MD, a clinical professor of medicine at the University of California, San Francisco. “If our ultimate goal is to help patients achieve their goals, the mechanism is not all that relevant.”

    How to Try Acupuncture

    How much of a benefit you receive may depend on the severity of your arthritis, and how often you get treated, Rhudy says. Yet multiple sessions may not be cost effective, considering that acupuncture prices can range from $75 to $200 per session. Before trying acupuncture, check to see if your insurance will cover part or all of the cost. Many U.S. insurers do provide some acupuncture coverage,” says C. James Dowden, executive administrator of the American Academy of Medical Acupuncture. “But what conditions they cover vary.”

    In some states Medicaid will cover a limited number of acupuncture sessions for specific diagnoses as will some Medicare Advantage plans. Traditional Medicare, however, will not pay for acupuncture.

    If you’d like to try acupuncture, it’s important to find a trained and experienced practitioner. Diplomates of acupuncture have at least four years of academic training at the master’s level, must pass rigorous exams and meet state licensing and continuing education requirements. Ask your doctor to recommend an acupuncturist or search for one in your area through the Arthritis Foundation’s Arthritis Resources Finder or the National Certification Commission for Acupuncture and Oriental Medicine website.

    By Laura L. Eckland

    Acupuncture is one of the oldest medical procedures in the world, with its origins dating back to China more than 2,000 years ago. When properly administered, it can have an amazing ability to naturally relieve arthritic conditions: pain and inflammation of the joints.

    Traditional Chinese medicine is based on the belief that an essential like force call “qi”(pronounced “chee”) flows through the body along channels called meridians. These Meridains are like rivers that irrigate the body and nourish the tissues. Any obstructions (called “bi”) aling these channels is like a dam that blocks vital energy flow, creating pain and diseases. Acupuncture is a very effective fomr of pain control in that it can relieve soreness in threee ways. First, it casuses the body to produce chemicals called endorphins, whick inhibit the perception of pain naturally. Secont, it blocks the transmission of pain signals to the brain through the nervous system. Thirdly, it deactivates trigger points. Trigger points are tender and extremely reactivate areas that develope within muscles. The result of acupuncture is widespread relaxation of both mind and body.

    Arthritis is a pervasive disease that causes pain and inflammation in joints and can be widely spread throughout the body. Arhritis isn’t just one disease, it is a complex disorder that comprises more that 100 distinct conditions and can affect people at any stage of life. The commmon thread among arthritis symptom is persistant joint pain and inflammation of the joints. While arthritis pain and inflammation cannot be avoided as the body agess, with the aid of acupuncture and Oriental medicine the pain can be managed to a greater degree and improve functioning.

    Acupunture treatment points for arthritis are located all over the body, not just directly over the affected area. During the treatment, tiny needles are place along the patient’s legs, arms, shoulders and even toes. These needles are so tiny that multiple acupuncture needles can fit inside a human hair. The needles stay on the area for set amount of time , and then removed. Most people relax and even fall asleep during the treatment. The length, number and frequency of treatments will vary according to the intensity of the pain, and its severity and pervasiveness with the patient.

    The relief of arthritis pain through acupuncture has been studied many times. Results indicate that the use of acupuncture and Oriental medicine can be an effective form of pain management. Many studies throughout the world have been given on a range of arthritis sufferers- from patients awaiting full-hip replacements, to knee surgery patients, as well as people suffering from the affects of rheumatoid and osteoarthritis. In most studies, the patients are split into groups- one group participating in acupuncture and Chinese medicine treatments in conjunction with a self-help course for managing their condition and conventional therapy; the other group receiving only the conventional therapy and self-help course information. The studies indicated that between 25-40 percent who received acupuncture in conjunction with the conventional and self therapy had a decrease in pain and a noted improvement in function of arthritic joints.

    The latest study by the US National Institutes of Health (NIH) is one of the largest and longest clinical trials to show such conclusive effects and patients who underwent acupuncture treatment reported a 44% average reduction in pain and a 40% improvement in mobility.

    Combining acupuncture with standard drug therapy can relieve pain and improve movement in people with arthritis of the knee, according to a new study conducted by Dr Brian Berman, from the University of Maryland School of Medicine in Baltimore, and was funded by the National Center for Complementary and Alternative Medicine (NCCAM) and the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS).

    In the trial, Dr. Berman and his colleagues studied 570 patients with an average age of 65 who had osteoarthritis of the knee. Participants were randomly assigned to receive one of three treatments for 26 weeks, in addition to standard care such as anti-inflammatory medications and pain relievers:

    • Acupuncture – inserting thin needles into certain body points to stimulate improved health.
    • Sham acupuncture – patients feel some sensation from a needle but it isn’t actually inserted.
    • A self-help course for managing pain.

    Throughout the 26 week trial, participants continued to receive their normal standard medical care, including anti-inflammatory drugs and pain relievers.

    By the eighth week, acupuncture patients showed a significant increase in function compared with both the sham treatment and self-help groups. By week 14, they were also experiencing a significant decrease in pain. By the end of the trial overall pain was reduced by about 40% and function improved by almost 40% in the volunteers receiving acupuncture.

    he popularity of acupuncture as a treatment for arthritis continues to grow because more and more people have found significant relief from Oriental medicine without the negative effects that sometimes accompany conventional Western medicine.. The best results for drastic reduction in pain and inflammation caused by arthritis is seen by combining conventional medicine with Oriental medicine- acupuncture, herbs, and therapeutic massage. Herbal medicine strengthens the body and enhances the immune system. Massage increases circulation in affected areas and helps to deactivate painful trigger points.

    Acupuncture: Can It Help My Rheumatoid Arthritis?

    Rheumatoid Arthritis (RA) is a chronic, inflammatory systemic illness that affects the whole body, especially the joints. It is also an autoimmune disease, which means that the immune system in the body, usually responsible for fighting off infections, also mistakenly begins to attack healthy tissue.

    One of the most common symptoms of RA is joint pain. People suffering from pain conditions, such as RA-related joint pain, may be interested in trying acupuncture treatment. Acupuncture is not a cure for RA, but it may provide some temporary relief of RA-related joint pain.

    What Is Acupuncture?

    Acupuncture treatment, which has been practiced for over 2,500 years, is rooted in traditional Chinese medicine (TCM) and is based on the theory of “qi” (sometimes spelled “chi,” “ch’i” or “ki”), the body’s vital energy or life force.

    In TCM, qi controls the workings of the body and is concentrated in 12 main meridians (pathways in the body) that correspond to 12 major bodily functions. If one’s qi is in balance, the body is healthy; if not, the body experiences symptoms such as pain. A traditional Chinese medical evaluation is performed with an examination of the tongue and the pulse. The treatment is designed to restore the patient’s energy balance.

    How Acupuncture Works

    Acupuncture que stimulates specific “acupoints,” (sometimes, but not always, located at the site of the symptom), using fine needles.

    Studies show that most acupoints cluster near nerves. When a needle is placed, patients typically report soreness, tingling, and electrical sensations, which are associated with nerves being activated. Needle placement activates the nerve and sends a signal to the spinal cord and brain, the pain centers of the nervous system. These are then activated to produce endorphins, the body’s natural pain reliever. The theory is that this is how acupuncture works to fight pain.

    What It Can Do

    Studies have shown some evidence that acupuncture can help patients with chronic pain (pain lasting longer than three months), and also may relieve back pain disability. Acupuncture has also been found to be helpful in treating low back pain, and pain from other conditions, such as osteoarthritis, fibromyalgia, carpal tunnel syndrome, and headaches.

    Acupuncture Treatment and Rheumatoid Arthritis

    Acupuncture has not been shown to prevent joint damage, and study data is conflicting as to whether acupuncture controls inflammation. Although there is no positive proof that acupuncture reduces inflammation, this has occasionally been reported.

    Acupuncture can, however, help with RA-related pain, just as it does with other types of pain, through the stimulation of endorphin production. Acupuncture should not be used as the sole treatment for RA, but rather as an additional treatment, in conjunction with RA disease-modifying medications. It is a tool to fight pain with minimal side effects, which can be undertaken along with medication treatment.

    What to Expect at an Acupuncture Appointment

    Whether the practitioner is a medical doctor with acupuncture certification, or a licensed nonphysician acupuncturist, his or her credentials should be displayed in the office.

    The patient should expect:

    • T be positioned comfortably during treatment.
    • To have the skin cleansed with alcohol prior to the placement of needles.
    • To have the needles placed 1-2 centimeters deep.
    • For the needles to be single-use, sterilized and disposed of after use.

    After the needles have been placed by the practitioner, they may be stimulated manually or electrically, and a warming lamp may be used. Acupuncture needles are thinner than injection hypodermic needles, so the insertion should feel akin to a mosquito bite. The patient may experience tingling, soreness, or an electrical sensation as the needles are being manipulated.

    Everyone’s response is unique, but the patient is likely to feel a sense of relaxation and well-being during treatment.

    It is important for a patient to communicate any concerns they may have prior to undergoing treatment and make note of any easily accessible ways to contact the practitioner should a need for assistance arise. In some instances, the practitioner may leave the room once the needles have been placed to give the patient time to relax.

    Side Effects

    Potential side effects for some people include:

    • Mild aching.
    • Bruising or redness at the needle placement site.
    • Light-headedness right after treatment.
    • Nausea.

    Uncommon side effects include infections and nerve injury; but these are extremely rare when the treatment is performed by a licensed acupuncturist.

    Patients should always discuss acupuncture with their individual physicians, prior to undergoing treatment, since certain conditions may make it ill-advised. For example, if a patient is taking a blood-thinning medication, extra care would need to be taken. Also, if a patient has a seizure disorder or irregular heartbeat, then the practice of electroacupuncture, (in which a small electric current is passed between pairs of acupuncture needles), should be avoided.

    Is Acupuncture Treatment Covered by Insurance?

    Unfortunately, Medicare does not cover acupuncture, and only some insurance plans do. Standard treatment for pain is 6 to 10 treatments spread over 3 to 5 weeks. Ask your acupuncturist how many treatments are needed to see an improvement in your pain.

    Typically, after 6 to 10 treatments, the patient may continue treatment at a lower frequency, or stop the treatment and resume on an as-needed basis.

    In Summary

    Acupuncture may be a safe and effective treatment for RA related pain, but it is not a substitute for disease-modifying medication treatment. Always consult your physician before starting treatment, to discuss whether this might be an option for you.

    Summary by Kathryn Klingenstein, L.M.S.W.

    For more helpful information, visit the following websites:

    • American Academy of Medical Acupuncture
    • HSS Integrative Care Center
    • Memorial Sloan-Kettering Cancer Center: Integrative Medicine

    Posted: 2/25/2013

    Authors

    Charis F. Meng, MD
    Assistant Attending Rheumatologist, Hospital for Special Surgery
    Assistant Professor of Medicine, Weill Cornell Medical College &nbsp

    Treating Hip Pain With Acupuncture

    If nothing you’ve tried to relieve hip pain has worked, and you’re not ready to undergo hip surgery, there might be one more treatment option for you to investigate: acupuncture.

    Acupuncture is an alternative treatment that has been successful in treating chronic pain, including joint pain. (Acupuncture seems to be particularly effective at relieving knee pain, the subject of most of the available pain studies.)

    Acupuncture is an ancient Chinese therapy that has been used to cure ailments and illnesses for thousands of years. Thin, tiny needles are placed into particular points in the skin, then can be adjusted with the hands or stimulated with gentle electrical currents.

    Acupuncture has been used to treat:

    • Chronic pain
    • Knee pain
    • Back pain
    • Osteoarthritis
    • Disc pain
    • Neck pain
    • Stress
    • Pregnancy pain (pelvic girdle)

    A series of acupuncture visits is usually needed to receive real relief. Sometimes, insurance companies may cover the cost of acupuncture therapy, but every plan is different, so it’s important to check before making an appointment.

    As with any treatment, acupuncture has its benefits and drawbacks.

    Acupuncture Pros

    • Many people with pain find relief from acupuncture when they couldn’t find relief from other sources.
    • When a qualified practitioner is performing acupuncture with sterile, nontoxic needles, the risks are very rare.
    • The effects of treatment is limited (they may only last for a few months).

    Acupuncture Cons

    • Acupuncture visits are expensive and the costs can mount up quickly if your insurance company doesn’t cover them.
    • While acupuncture is generally a very safe procedure when performed correctly by a qualified practitioner, it can be dangerous if certain steps aren’t taken. For example, unsterilized needles can cause infection, and punctured organs could result if the practitioner incorrectly inserts the needles.

    Acupuncture: Does It Work for Hip Pain?

    Very few researchers have investigated the benefits of acupuncture specifically on hip pain, although one study showed improvements in pain following hip surgery.

    “I tried it because I had tried other things. I was at the point was just part of the process for me,” says Ellen Schmidt, 42, who tried acupuncture when pain medications and cortisone shots didn’t offer relief. Schmidt had three or four sessions at a well established clinical center. But, unfortunately, there were no improvements in her hip pain, which was significant and caused her to limp. “I really wanted it to be successful for me,” Schmidt says. “I had a very open mind.”

    Schmidt eventually turned to hip surgery to relieve her hip pain; however, she still doesn’t totally discount acupuncture. Perhaps those with hip problems that aren’t as advanced as hers, she says, might find relief through acupuncture. She had significant damage to her hip joint, maybe too much to feel any effects of the treatment.

    Acupuncture may not provide relief for everyone. And, you have to be concerned about the treatment costs and finding a qualified acupuncturist. But if you can’t ease your hip pain through other therapies and surgery isn’t yet an option, acupuncture might be worth considering.

    Acupuncture may be an effective therapy for hip osteoarthritis. A recent study reviewed the small number of clinical trials that have been conducted to investigate the effectiveness of this potential therapy.

    Osteoarthritis is a painful, chronic condition that occurs when the protective cartilage in the joints wears away due to age or prolonged wear and tear. Hip osteoarthritis affects somewhere between 3 and 11% of adults in Western countries. There is no cure, with most treatments involving exercise, physical therapy, or pain-killing and anti-inflammatory drugs. Severe hip osteoarthritis may require surgery, and 200,000 hip replacements are performed in the United States every year.

    Traditional Chinese acupuncture involves inserting needles into specific parts of the body. This is based on a belief that energy circulates throughout the body along certain pathways, and that the disruption of this energy flow can cause pain or ill health. According to this belief, inserting needles into key nodes in the energy pathways can re-normalize energy flow. There is no scientific evidence for this concept.

    There has been some evidence that inserting acupuncture needles could stimulate the body to release natural pain-killing molecules, or could temporarily decrease the ability of the nervous system to sense pain. Furthermore, acupuncture is a relatively safe procedure. There have been a number of clinical trials attempting to test the effectiveness of acupuncture as a treatment for hip osteoarthritis.

    A group of American and Chinese researchers sought to collect the results of all these previous studies, and re-analyze the results as a group. They recently published the results of their study in the Cochrane Database of Systematic Reviews.

    Acupuncture had a low risk of serious side effects

    The researchers searched the scientific literature for clinical trials comparing acupuncture to other treatments in patients with hip osteoarthritis. They found six clinical trials meeting their criteria. Participants in the trials had average ages ranging from 61 to 67 years, and two-thirds of them were women. They had experienced hip osteoarthritis pain for an average of two to eight years prior to the studies.

    Patients received acupuncture for between 4 and 13 weeks. Four of these trials included information on the safety of the treatment; none of them reported any serious adverse effects due to acupuncture. There were minor side effects in some patients, such as minor bruising, pain or bleeding where needles were inserted.

    Acupuncture is not better than sham acupuncture for treating hip osteoarthritis

    In the ideal clinical trial, both the study participants and the personnel conducting the study are “blinded”. That is, they are not aware of who is receiving the treatment or the control treatment that it is being compared to.

    Blinding in clinical trials is important for two reasons. First, the knowledge of who is receiving certain treatments could result in study personnel treating the two groups differently. For example, doctors may pay more attention to study participants who are receiving the treatment of interest, potentially resulting in them getting better medical care than those in the control group. Second, patients knowingly receiving the treatment may experience a placebo effect, where their preconceived ideas of the treatment’s effectiveness could actually increase its effect through biological mechanisms that are still unclear. This is obviously a challenging problem for an acupuncture study, where it is very difficult to hide the fact that someone received the treatment.

    Some studies approach the issue of trial blinding by comparing acupuncture to a sham acupuncture procedure. Sham acupuncture uses needles that do not actually penetrate the skin, or that are inserted in improper locations.

    The researchers found two studies that compared the effectiveness of acupuncture to a sham acupuncture procedure. Both studies found that acupuncture was no better than the sham procedure at decreasing pain or improving hip function. One study found that acupuncture resulted in a small improvement to the study participant’s perception of their quality of life; the other study did not attempt to measure the quality of life.

    The researchers assessed the quality of the clinical studies that they reviewed. They rated the sham acupuncture studies as of medium quality, with the main deficiency being their small size (62 and 88 participants).

    Weak evidence that acupuncture is more effective than conventional hip osteoarthritis therapy

    The researchers found four studies that compared the effectiveness of conventional medical care alone to conventional medical care in addition to acupuncture. However, they rated these studies to be of low, or very low, quality. These studies were also very small (between 28 and 137 participants), did not blind the study participants or the study staff, and some studies may have allowed study participants to choose whether they were in the acupuncture or control groups.

    The least-poor of these studies found that acupuncture plus routine physician care was more effective than routine care alone at decreasing pain, improving bodily function and increasing physical, but not mental, quality of life. The researchers considered the remaining studies to be of very low quality. Two of these studies reported that the combination of acupuncture and conventional care was superior to conventional care alone (patient education or diclofenac, an anti-inflammatory drug). The final study found that the combination of acupuncture, advice and exercise was not more effective than advice and exercise alone.

    A need for high-quality clinical studies of acupuncture and hip osteoarthritis

    Overall, the researchers concluded that acupuncture likely offers no benefit over sham acupuncture. There is evidence that acupuncture was superior to conventional therapy, but weaknesses in the design of the clinical trials limited the reliability of these results. Notably, many of these studies did not account for placebo effects.

    Better quality studies, with more participants and proper blinding, are needed to conclusively determine if acupuncture is truly effective for hip osteoarthritis. However, acupuncture did not cause any serious adverse effects. If individual patients wish to pursue this option in addition to standard therapy, it should be safe to do so.

    Written by Bryan Hughes, PhD

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