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Journal of Chinese Integrative Medicine ›› 2005, Vol. 3 ›› Issue (6): 421-425.doi: 10.3736/jcim20050601

• Expert Forum •     Next Articles

Evaluating the effects of acupuncture on knee osteoarthritis: A stepwise approach to research, University of Maryland experience

Li-xing Lao,Brian Berman   

  1. Center for Integrative Medicine, School of Medicine, University of Maryland, Third Floor, James Kernan Hospital Mansion, 2200 Kernan Drive, Baltimore, Maryland 21207, USA
  • Received:2005-08-16 Online:2005-11-20 Published:2005-11-20
  • Contact: Lixing Lao, Ph.D.

Conventional treatments for osteoarthritis (OA), the most common form of arthritis, are associated with unpleasant adverse effects and often ineffective. Acupuncture and traditional Chinese medicine (TCM) have been used for thousands of years to treat pain and other dysfunctions. However, the scientific evidence on the efficacy of acupuncture and TCM is equivocal, and adapting the Western biomedical model to assess them is a great challenge. By adopting a systematic, step-by-step approach, the research team at the University of Maryland has been carefully evaluating the effectiveness of acupuncture on knee OA over the past 10 years. Their successful experience may be a useful model for future acupuncture and TCM research.

Key words: Osteoarthritis, Knee, Randomized controlled clinical trials, Outcome assess, Acupuncture therapy

CLC Number: 

  • R245.31


类型 主要特点
Ⅰ期 药物作用、合适剂量、安全性的预初研究。采用典型的非随机化的人体初步试验,通常不设对照组。
Ⅱ期 疗效评价的预初研究,进一步研究药物的剂量和安全性。试验可以是随机化的。比Ⅰ期的研究规模大,
Ⅲ期 评估剂量效应,评价长期使用的安全性和有效性。试验是随机化的。治疗必须显示良好的风险/效益比。


[1] Somerville K, Faulkner G, Langman M . Non-steroidal anti-inflammatory drugs and bleeding peptic ulcer[J]. Lancet, 1986,1(8479):462-464
[2] Brooks PM, Potter SR, Buchanan WW . NSAID and osteoarthritis--help or hindrance?[J]. J Rheumatol, 1982,9(1):3-5
[3] Perneger TV, Whelton PK, Klag MJ . Risk of kidney failure associated with the use of acetaminophen, aspirin, and nonsteroidal antiinflammatory drugs[J]. N Engl J Med, 1994,331(25):1675-1679
doi: 10.1056/NEJM199412223312502
[4] Buffum M, Buffum JC . Nonsteroidal anti-inflammatory drugs in the elderly[J]. Pain Manag Nurs, 2000,1(2):40-50
doi: 10.1053/jpmn.2000.7779
[5] Stiel D . Exploring the link between gastrointestinal complications and over-the-counter analgesics: current issues and considerations[J]. Am J Ther, 2000,7(2):91-98
doi: 10.1097/00045391-200007020-00006
[6] Davies NM, Jamali F . COX-2 selective inhibitors cardiac toxicity: getting to the heart of the matter[J]. J Pharm Pharm Sci, 2004,7(3):332-336
[7] NIH Consensus Conference . Acupuncture[J]. JAMA, 1998,280(17):1518-1524
doi: 10.1001/jama.280.17.1518
[8] Berman BM, Lao L, Langenberg P , et al. Effectiveness of acupuncture as adjunctive therapy in osteoarthritis of the knee: a randomized, controlled trial[J]. Ann Intern Med, 2004,141(12):901-910
doi: 10.7326/0003-4819-141-12-200412210-00006
[9] Ernst E . Acupuncture as a symptomatic treatment of osteoarthritis. A systematic review[J]. Scand J Rheumatol, 1997,26(6):444-447
doi: 10.3109/03009749709065717
[10] Ezzo J, Hadhazy V, Birch S , et al. Acupuncture for osteoarthritis of the knee: a systematic review[J]. Arthritis Rheum, 2001,44(4):819-825
doi: 10.1002/(ISSN)1529-0131
[11] Lao L, Ezzo J, Berman B , et al. Assessing clinical efficacy of acupuncture: Considerations for the future design of clinical trials in acupuncture[A]. In: Stux G, Hammerschlag R (Eds.). Scientific basis of acupuncture[M]. Berlin: Springer-Verlag, 2000. 187-209
[12] FDA. CDER Handbook[M/OL]. 2005.
[13] Niebuhr B. Handbook of clinical trial and epidemiological research designs[M/OL]. 2000.
[14] Cheng X. Chinese acupuncture and moxibustion(1st ed)[M]. Beijing: Beijing Foreign Languages Press .,1987,(1st ed):
[15] O'Connor J , Bensky D.Acupuncture-A comprehensive text(1st ed)[M]. Chicago: Eastland Press.,1981,(1st ed):
[16] Berman BM, Singh BB, Lao L , et al. A randomized trial of acupuncture as an adjunctive therapy in osteoarthritis of the knee[J]. Rheumatology (Oxford), 1999,38(4):346-354
doi: 10.1093/rheumatology/38.4.346
[17] Berman B, Lao L, Greene M , et al. Efficacy of traditional Chinese acupuncture in the treatment of symptomatic knee osteoarthritis: a pilot study[J]. Osteoarthritis Cartilage, 1995,3(2):139-142
doi: 10.1016/S1063-4584(05)80046-9
[18] Lao L, Bergman S, Hamilton GR , et al. Evaluation of acupuncture for pain control after oral surgery: a placebo-controlled trial[J]. Arch Otolaryngol Head Neck Surg, 1999,125(5):567-572
doi: 10.1001/archotol.125.5.567
[19] Lao L, Zhang RX, Zhang G , et al. A parametric study of electroacupuncture on persistent hyperalgesia and Fos protein expression in rats[J]. Brain Res, 2004,1020(1-2):18-29
doi: 10.1016/j.brainres.2004.01.092
[20] Zhang RX, Lao L, Wang L , et al. Involvement of opioid receptors in electroacupuncture-produced anti-hyperalgesia in rats with peripheral inflammation[J]. Brain Res, 2004,1020(1-2):12-17
doi: 10.1016/j.brainres.2004.05.067
[21] Zhang RX, Lao L, Wang X , et al. Electroacupuncture combined with indomethacin enhances antihyperalgesia in inflammatory rats[J]. Pharmacol Biochem Behav, 2004,78(4):793-797
doi: 10.1016/j.pbb.2004.05.010
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