Acupuncture, Herbs and Nutrients for Knee Pain

compiled by John G. Connor, M.Ac., L.Ac. and Barbara Connor, M.Ac., L.Ac.

Barbara & I would like to share with you today 13 studies on the beneficial effects of acupuncture on knee pain as well as 8 studies on the beneficial effects of various herbs and nutrients on knee pain.  We hope you find this information useful in your quest for optimal knee health.

Studies on the Beneficial Effects of Acupuncture on Knee Pain

  • Evaluation of the Effectiveness of Acupuncture in the Treatment of Knee Osteoarthritis: A Case Study The present case study included two patients with clinical signs of osteoarthritis and diagnosis of medial pain, as defined by the Heidelberg Model of TCM. Over 6 weeks, those patients were treated with acupuncture, with a frequency of one session a week. The sessions lasted for thirty minutes and were based on the needling of 4 local acupoints. Before and after each session, pain and mobility assessments were performed. Results: The results were positive, with significant reduction of pain and increased knee joint flexion amplitude and mobility. Conclusion: Acupuncture was effective as an alternative or complementary treatment of knee osteoarthritis, with high levels of improvement within a modest intervention period. (Teixeira et al 2018)   
  • Drug-Free Interventions to Reduce Pain or Opioid Consumption After Total Knee Arthroplasty: A Systematic Review and Meta-analysis. In this meta-analysis, electrotherapy and acupuncture after total knee arthroplasty were associated with reduced and delayed opioid consumption. (Tedesco et al 2017)
  • Electro-Acupuncture (EA) is Beneficial for Knee Osteoarthritis (KOA): The Evidence from Meta-Analysis of Randomized Controlled Trials.  Conclusively, the results indicate that electro-acupuncture is a great opportunity to remarkably alleviate the pain and improve the physical function of knee osteoarthritis (KOA) patients with a low risk of adverse reaction. Therefore, more high quality RCTs with rigorous methods of design, measurement and evaluation are needed to confirm the long-term effects of electro-acupuncture for knee osteoarthritis. (Chen et al 2017)
  • Warm-needling moxibustion for knee osteoarthritis:a randomized controlled trial Fifty cases of knee osteoarthritis were randomly divided into an observation group (25 cases) and a control group (21 cases), but 4 cases lost contact. Warm-needling moxibustion could relieve pain, improve function and muscle balance, strengthen extensor and flexor muscle power, especially extensor, which has superior clinical efficacy. (Wang et al 2017)
  • Therapeutic effect observation of chronic knee joint pain assisted with the central-square needling technique of the thumb-tack needles. At the end of follow-up visit, Lequesne index scores were all improved as compared with those before treatment in the two groups (both P<0.05) and the improvements were similar between the two groups (P>0.05) The acupuncture scheme in assistance with the central-square needling technique of thumb-tack needles obviously relieves chronic knee joint pain, much better sustains the analgesic effects of acupuncture and improves patient compliance. (Yang et al 2017)
  • Influence of acupuncture in treatment of knee osteoarthritis and cartilage reparing. These results indicate that acupuncture represents certain clinical effect on knee osteoarthritis  which is superior compared with physiotherapy, and hint the possible roles of acupuncture in promoting cartilage  repairing. (Zhang et al 2016)
  • Acupuncture for postoperative pain, a literature review. Five controlled trials and two systematic reviews were selected.  In knee replacement, acupuncture reduced pain by 2% and analgesic consumption by 42%. Acupuncture may be useful to manage postoperative pain, but more controlled studies are required. (Fuentealba Cargill & Biagini Alarcon 2016)
  • Acupuncture is Effective for Chronic Knee Pain: A Reanalysis of the Australian Acupuncture Trial.  Compared with conventional care, acupuncture treatment was found to be moderately effective for chronic knee pain in patients aged 50 years and older. (Fan et al 2016)
  • Effective chronic low back pain and knee pain treatment with acupuncture in geriatric patients. This study showed mean back pain scores (8.8696 ± 1.546) and mean knee pain scores (9.1304 ± 1.4239) of patients were reduced significantly to 2.1739 ± 1.466 and 1.455 ± 0.7; p< 0.001 respectively after the acupuncture treatment. These are important results as they give rationale to use acupuncture treatment widely in chronic low back pain and knee pain in the geriatric group of patients to reduce the side effects of polypharmacy in elderly. (Cevik et al 2015)
  • The combined therapy of acupuncture and moxibustion achieves the safe and effective therapeutic effect with less adverse reactions in the treatment of knee osteoarthritis. The immediate effect in the combined therapy group is not so obvious as compared with the western medication, but the long-term efficacy is remarkably superior to western medication. (Xu et al 2013)
  • Acupuncture provided significantly better relief from knee osteoarthritis pain and a larger improvement in function than sham acupuncture, standard care treatment, or waiting for further treatment. (Cao et al 2012)
  • Acupuncture that meets criteria for adequate treatment is significantly superior to sham acupuncture and to no additional intervention in improving pain and function in patients with chronic knee pain. Due to the heterogeneity in the results, however, further research is required to confirm these findings and provide more information on long-term effects. (White et al 2007)
  • A randomized trial of acupuncture as an adjunctive therapy in osteoarthritis of the knee. Seventy-three patients with symptomatic OA of the knee were randomly assigned to treatment (acupuncture) or standard care (control). Significant differences on total WOMAC [Western Ontario and McMaster Universities Osteoarthritis Index: subindexes for pain, stiffness, and physical function] Scale were seen at 4 and 8 weeks. There appears to be a slight decline in effect at 4 weeks after cessation of treatment (12 weeks after first treatment). No adverse effects of acupuncture were reported.These data suggest that  acupuncture is an effective and safe adjunctive therapy to conventional care for patients with osteoarthritis of the knee. (Berman et al 1999)

Studies on the Beneficial Effects of Various Herbs and Nutrients on Knee Pain

    • Ajuga decumbens extract
    • Avocado soybean unsaponifiables
    • Boswellia serrata
    • Chondroitin sulfate
    • Collagen hydrolysate
    • Curcuma longa rhizome
    • Devil’s claw (Harpagophytum procumbens)
    • Glucosamine and chondroitin
    • Green-lipped mussel extract
    • Hydrolyzed Collagen, Chondroitin Sulfate and Glucosamine
    • L-carnitine
    • Methylsulfonylmethane (MSM)
    • Passion fruit peel extract
    • Pycnogenol
    • Terminalia chebula fruit
    • Undenatured type II collagen
  • A Placebo-Controlled Double-Blind Study Demonstrates the Clinical Efficacy of a Novel Herbal Formulation for Relieving Joint Discomfort in Human Subjects with Osteoarthritis of Knee.  At the end of the trial period, LI73014F2 ( a novel composition prepared from extracts of Terminalia chebula fruit, Curcuma longa rhizome, and Boswellia serrata gum resin with synergistic benefit in 5-Lipoxygenase (5-LOX) inhibition) conferred significant pain relief, improved physical function, and quality of life in osteoarthritis patients. In conclusion, preclinical and clinical data together strongly suggest that the herbal formulation LI73014F2 is a safe and effective intervention for management of joint discomfort, demonstrating efficacy as early as 14 days. (Karlapudi et al 2018)
  • Efficacy of Chondroitin Sulfate for Painful Knee Osteoarthritis: A One-Year, Randomized, Double-Blind, Multicenter Clinical Study in Japan. Serum level of cartilage oligomeric matrix protein and hyaluronic acid were also determined. In the subgroup with severe symptoms (Lequesne’s index ≥8), the chondroitin sulfate dose of 1560 mg/d improved pain faster after 6 and 9 months’ therapy. However, no dose-related effects were found on cartilage oligomeric matrix protein or hyaluronic acid levels. Chondroitin sulfate also had good tolerability. We conclude that chondroitin sulfate is useful for pain control in knee osteoarthritis. (Morita et al 2018)
  • Effectiveness of a Dietary Supplement Containing Hydrolyzed Collagen, Chondroitin Sulfate, and Glucosamine in Pain Reduction and Functional Capacity in Osteoarthritis Patients. The total reduction in the Lequesne Functional Index was 6.30 ± 4.08 points after 6 months (p < .0001), with significant reductions in all subindexes of the scale. A similar pattern was found for the WOMAC index, with an overall reduction of 22.49 ± 14.03 points after 6 months (p < .0001) and significant reductions in all subindexes. No major adverse events were noted during the treatment. This exploratory study shows that treatment with the dietary supplement significantly reduces pain and improves locomotor function in patients with OA of the knee and/or hip. (Puigdellivol let al 2018)
  • Dietary supplements for treating osteoarthritis: a systematic review and meta-analysis. Of 20 supplements investigated in 69 eligible studies, 7 (collagen hydrolysate, passion fruit peel extract, Curcuma longa extract, Boswellia serrata extract, curcumin, pycnogenol and L-carnitine) demonstrated large (effect size >0.80) and clinically important effects for pain reduction at short term. Another six (undenatured type II collagen, avocado soybean unsaponifiables, methylsulfonylmethane, diacerein, glucosamine and chondroitin) revealed statistically significant improvements on pain, but were of unclear clinical importance. Only green-lipped mussel extract and undenatured type II collagen had clinically important effects on pain at medium term. The overall analysis including all trials showed that supplements provided moderate and clinically meaningful treatment effects on pain and function in patients with hand, hip or knee osteoarthritis at short term, although the quality of evidence was very low. (Liu et al 2018)
  • Evaluation of the efficacy of Ajuga decumbens extract supplement in individuals with knee discomfort associated with physical activity: A randomized, double-blind, placebo-controlled study. In conclusion, these observations suggest that the administration of an Ajuga decumbens extract-containing diet is safe and improves joint function (flexion and stiffness) and general activity in subjects with mild knee discomfort. Therefore, Ajuga decumbens extract could be a promising candidate as a functional food that is beneficial to joint health. (Sawada et al 2017)
  • Benefits of antioxidant supplements for knee osteoarthritis: rationale and reality. This review shows that there is some evidence for benefits of antioxidant supplements in pain relief and function in knee osteoarthritis. These supplements with the most evidence include curcumin, avocado-soya bean unsaponifiables, Boswellia and several preparations used in Ayurvedic and Chinese medicine. These should be tested further and used, at least, to decrease the use of NSAIDs which have more adverse effects. Ancient medicine should be tested as such rather than proprietary products made from them. It should be assessed whether diet with turmeric and black pepper results in sufficient levels of serum curcumin. Promotion of dietary habits may be more economical and of longer term benefit than the development of products made from extracts used in ancient medicine. (Grover & Samson 2016)
  • Treatment of patients with arthrosis of hip or knee with an aqueous extract of devil’s claw (Harpagophytum procumbens DC.). The results of the study revealed a strong reduction of pain and the symptoms of osteoarthritis. There was a relevant improvement of each WOMAC subscale as well as of the total WOMAC index: 23.8% for the pain subscale, 22.2% for the stiffness subscale and 23.1% for the physical function subscale. The WOMAC total score was reduced by 22.9%. VAS pain scores were decreased by 25.8% for actual pain, 25.2% for average pain, 22.6% for worst pain and 24.5% for the total pain score. The physicians reported a continuous improvement in typical clinical findings such as 45.5% for pain on palpation, 35% for limitation of mobility and 25.4% for joint crepitus. Only two cases of possible adverse drug reactions were reported (dyspeptic complaints and a sensation of fullness). Although this was an open clinical study, the results suggest that this Devil’s claw extract has a clinically beneficial effect in the treatment of arthrosis of the hip or knee. (Wegener & Lupke 2003)

  • Efficacy and tolerability of Boswellia serrata extract in treatment of osteoarthritis of knee–a randomized double blind placebo controlled trial.  All patients receiving drug treatment reported decrease in knee pain, increased knee flexion and increased walking distance. The frequency of swelling in the knee joint was decreased. Radiologically there was no change. The observed differences between drug treated and placebo being statistically significant, are clinically relevant. Boswellia serrata extract was well tolerated by the subjects except for minor gastrointestinal ADRs. Boswellia serrata extract is recommended in the patients of osteoarthritis of the knee with possible therapeutic use in other arthritis. (Kimmatkar et al 2003)
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Compassionate Acupuncture and Healing Arts, providing craniosacral acupuncture, herbal and nutritional medicine in Durham, North Carolina. Phone number 919-309-7753.

This entry was posted in acupuncture, acute conditions, arthritis, bone health, botanical medicine, chronic conditions, herbal medicine, inflammation, inflammatory conditions, knee pain, moxibustion, musculoskeletal conditions, nutritional medicine, osteoarthritis, pain, Traditional Chinese Medicine and tagged , , , . Bookmark the permalink.

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