Osteoarthritis: a Systemati Review and meta-analysis
Robert PAIN
Pain can be broadly divided into three classes.
1. Nociceptive Pain 2. Inflamatory Pain 3. Pathological Pain Pain in Osteoarthritis • Osteoarthritis (OA) has long been considered a “wear and tear” disease leading to loss of cartilage. OA used to be considered the sole consequence of any process leading to increased pressure on one particular joint or fragility of cartilage matrix. • The discovery that many soluble mediators such as cytokines or prostaglandins can increase the production of matrix metalloproteinases by chondrocytes led to the first steps of an “inflammatory” theory. • Low-grade inflammation induced by the metabolic syndrome, innate immunity and inflammaging are some of the more recent arguments in favor of the inflammatory theory of OA. Pain Management with Acupuncture in Osteoarthritis: a Systemati Review and meta- analysis Manyanga, T., Froese, M., Zarychansku, R., Abou-Setta, A., Friesen, C., BMC Complementary and Alternative Medicine 2014, 9 pages doi:10.1186/1472-6882-14-312 Background • The utility of acupuncture in managing osteoarthritis symptoms is uncertain. Trial results are conflicting and previous systematic reviews may have overestimated the benefits of acupuncture. Method
• Two reviewers independently identified randomized
controlled trials (up to May 2014) from multiple electronic sources (including PubMed/Medline, EMBASE, and CENTRAL) and reference lists of relevant articles, extracted data and assessed risk of bias (Cochrane’s Risk of Bias tool). Pooled data are expressed as mean differences (MD), with 95% confidence intervals (CI) (random-effects model). Measurement Tools
• Pain intensity was measured using the visual Analogue
scale. • To assess functional mobility, the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scale was used. This scale rates activities according to degree of difficulty (0 = none and 4 = extreme difficult). • Other trials used the Knee injury and Osteoarthritis Outcome Score (KOOS) with five categories (0 = none and 5 = extreme) difficulty). Study Flow Diagram Result • We included 12 trials (1763 participants) comparing acupuncture to sham acupuncture, no treatment or usual care. We adjudicated most trials to be unclear (64%) or high (9%) risk of bias. • Acupuncture use was associated with: I. Significant reductions in pain intensity (MD -0.29, 95% CI -0.55 to - 0.02, I2 0%, 10 trials, 1699 participants) II. Improvement in Functional mobility (standardized MD -0.34, 95% CI -0.55 to -0.14, I2 70%, 9 trials, 1543 participants) III. Improvement in Health-related quality of life (standardized MD - 0.36, 95% CI -0.58 to -0.14, I2 50%, 3 trials, 958 participants). IV. Subgroup analysis of pain intensity by intervention duration suggested greater pain intensity reduction with intervention periods greater than 4 weeks (MD -0.38, 95% CI -0.69 to -0.06, I2 0%, 6 trials, 1239 participants). Visual Analog Scale Functional Mobility Health-related quality of life Conclusion • The use of acupuncture is associated with significant reductions in pain intensity, improvement in functional mobility and quality of life. While the differences are not as great as shown by other reviews, current evidence supports the use of acupuncture as an alternative for traditional analgesics in patients with osteoarthritis. Reference Woolf, C. J. (2010). What is this thing called pain? Journal of Clinical Investigation, 120(11), 3742–3744. doi:10.1172/jci45178 Manyanga, T., Froese, M., Zarychanski, R., Abou-Setta, A., Friesen, C., Tennenhouse, M., & Shay, B. L. (2014). Pain management with acupuncture in osteoarthritis: a systematic review and meta- analysis. BMC Complementary and Alternative Medicine, 14(1). doi:10.1186/1472-6882-14-312 Berenbaum, F. (2013). Osteoarthritis as an inflammatory disease (osteoarthritis is not osteoarthrosis!). Osteoarthritis and Cartilage, 21(1), 16–21. doi:10.1016/j.joca.2012.11.012 THANK YOU