Acupuncture for Knee Osteoarthritis Pain

Summary

Reviews often find acupuncture reduces knee osteoarthritis pain, but the certainty is low, and professional guidelines split: one conditionally recommends it in a narrow group, one strongly recommends against it, and NICE says not to offer it. Evidence label: mixed. For background on interpreting sham-controlled trials see what is acupuncture.

What the reviews found

• NCCIH summary of a 2018 review. In studies mostly of knee osteoarthritis, acupuncture was more effective than no treatment (10 studies, 2,413 people) and more effective than sham (9 studies, 2,376 people). The gap against no treatment was larger than against sham. The effect was comparable to NSAIDs. [1]
• 2024 review and network meta-analysis. 80 trials, 9,933 people. Very low certainty evidence suggested acupuncture may reduce pain compared with sham, NSAIDs, usual care or waiting list, but not compared with joint injections. Electroacupuncture and higher doses appeared to do better, an exploratory finding. [2]
• Individual-patient analysis (2018). In pooled chronic pain trials that included osteoarthritis, acupuncture beat sham and no acupuncture, and the authors concluded benefit was not explained by placebo effects alone. [3]
• Older Australian study cited by NCCIH. Needle and laser acupuncture were modestly better than no treatment for knee pain but not better than simulated laser acupuncture. NCCIH adds that expectation and belief may play important roles. [4]

What guidelines say

NCCIH also states that the rheumatology guideline conditionally recommends acupuncture for osteoarthritis of the knee, hip or hand more broadly in a 2019 clinical practice guideline, noting that the most studies showing benefit are in knee osteoarthritis. [1] The two NCCIH pages summarize the same guideline differently, so check the original if the exact wording matters to you.

Hip and other joints

A 2018 review of six studies (413 people) of hip osteoarthritis found two sham-controlled studies with little or no difference in pain. [1]

Benefits, limits and safety

Pain relief, if it comes, is likely modest, and sham-controlled gains are smaller than gains over no treatment. Ask your clinician how acupuncture fits with your other osteoarthritis care. See side effects and precautions and licensing and training. Do not use complementary approaches to postpone seeing a clinician about joint symptoms. [4]