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Clinical Crossroads | Clinician's Corner

A 60-Year-Old Woman Considering Acupuncture for Knee Pain

Brian Berman, MD, Discussant
JAMA. 2007;297(15):1697-1707. doi:10.1001/jama.297.15.1697.
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Mrs A, an active 60-year-old woman, has a history of degenerative osteoarthritis of her knee with pain that has progressed over the past 8 years. She has undergone arthroscopic surgery for a meniscal tear and has taken nonsteroidal anti-inflammatory drugs (NSAIDs), glucosamine, and chondroitin sulfate occasionally, but generally does not like taking medications. She is open to other therapeutic approaches and wants to know if acupuncture can help the pain, improve function, and stop her condition from progressing. The evidence for the effectiveness of acupuncture for knee pain and other common treatments, including exercise, NSAIDs, glucosamine and chondroitin, and intra-articular knee injections are compared, and costs and methods of acupuncture and selecting an acupuncturist are discussed.

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Figures

Figure 1. Radiograph of Mrs A’s Knee
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White arrowheads indicate location of osteophytes.

Figure 2. Common Acupuncture Points for Treatment of Knee Pain
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The acupuncture points in this figure represent some of the primary points used in traditional Chinese medicine to treat the main subcategories of “Bi” syndrome—the closest traditional Chinese medicine diagnosis for arthritis. These points were used in standardized treatment protocols in 2 of the large randomized controlled trials in Table 2.49,50 The other randomized controlled trials51,52 listed in Table 2 used a variety of standardized and individualized treatment protocols that included a minimum of 8 points, including some of those indicated. BL indicates bladder meridian; GB, gallbladder meridian; KI, kidney meridian; SP, spleen meridian; ST, stomach meridian. For additional information on accupuncture points, see Cheng X, ed. Chinese Acupuncture and Moxibustion. Beijing, China: Foreign Languages Press; 1987.

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