I wanted to talk a little about the ins and outs of acupuncture for knee pain… Not only because of the effectiveness I see in my own clinic every day in relieving knee pain, but because of the knowing that it could help so many more people.

From a personal perspective, chronic knee pain can be a life changer… preventing you from doing many of those activities you once loved and fear never being able to do again. For the many people I see in my clinic, simply playing with the grandchildren on the floor is something they are simply no longer able to do.

It is sometimes difficult to make sense of all the medical options available to you if you have knee pain. With medications, physical therapies, cortisone shots, rooster comb injections, surgeries and even knee replacements available, it is sometimes confusing or overwhelming.

For most patients, the chronic knee pain simply gets worse and worse over the years, with their doctors ramping up the invasiveness of their treatment until there is nothing left to try. Then its time for the pain clinic.

For the vast majority of people who come see me for knee pain, they have already been dealing with it for a very long time. Often years. Most have already gone down the path of conventional medicine, but with “so-so” results. They have gone to the therapists and gotten their x-rays and had the shots and perhaps even the surgeries…

With the increasing acceptance of acupuncture amongst medical doctors, many patients are increasingly being refereed to acupuncture for relief from their chronic knee pain. But sometimes even their doctor doesn’t know much more than what he or she may have seen on TV about acupuncture. It is unlikely they learned about it in medical school and since most of their continuing medical education is provided by pharmaceutical companies, it is unlikely they are taught anything about acupuncture’s usefulness there either.

Sometimes it may be best to simply observe what other doctors are doing around the world. As an example, organizations as large as the US military routinely utilize acupuncture for active duty personal. In Europe, the national health care systems of Germany, Italy, Britain, France, and many others regularly utilize acupuncture. In several countries including Germany, and Italy, acupuncture is considered the first line treatment for chronic low back pain and OA of the knee.

In Scharf’s 2006 paper Acupuncture and Knee Osteoarthritis: A Three-Armed Randomized Trial, they found that not only was acupuncture more effective in pain relief than standard care, but held on to that effectiveness more than 6 months after the end of the treatments.

In the case of knee pain, I often paint acupuncture as a form of “Physical Therapy” to my patients; meaning that the intent is to as quickly as possible provide long term pain relief and then cease treatments. In my clinic I very rarely see a knee pain patient more than 12 visits with the average being just 6 treatments.

Not too long ago, a MD referred “Shirley” to my office for knee pain. Although she was previously diagnosed with mild osteoarthritis, she had what was considered by her doctor, an unreasonable amount of pain for the degree of arthritis she had.

Because of the apparent mildness of her arthritis and young age, she was not yet a candidate for knee replacement surgery for several more years. She had been on several different medications and had received 2 rounds of cortisone shots. Her doctor suggested she try acupuncture for pain relief.

I recommended to Shirley that we start with three sessions to gauge how well she responded to the acupuncture. I explained to her that although three sessions is rarely enough to complete the therapy, we will then know at what rate she responds. After three sessions, she reported that the pain in her knee was 50% better. I recommended three additional treatments which improved the pain by 95%. She reported only very minor discomfort when first rising to a standing position; otherwise she no longer noticed any pain once she got moving. On our 7^th visit, she was released from treatment. Upon follow up 3 months later, she reported still remaining relatively pain free.

This tends to be a typical case. Unfortunately, there is a small number who do not respond well to this form of care. Thankfully, they are relatively easily to identify within just a few treatments. While it is rare to have a dramatic, long lasting improvement with a single treatment (as many see in movies or hear about from acquaintances), patients should see at least some slight improvement with the initial treatment followed by increasingly noticeable improvement with successive sessions. Occasionally, a patient will be what I call a “late bloomer” and not see any significant improvement until several sessions into the course of treatment.

If a patient does not see improvement after 3 treatments, I typically assume that they are one of the 15% who does not respond well to acupuncture and suggest ending future treatments.

A typical course of treatment frequency would be 3 sessions a week. If they see improvement, we will continue with 3 more sessions the following week and then reevaluate.

A typical visit to an acupuncturist lasts just under an hour. We will chat a bit, talk about the weather and their kids; evaluate the chief complaint and then conduct the treatment. We may typically insert 10-15 “filiform” threads (acupuncture needles) into specific acupuncture point locations around the knee, hands and ear. Once the needles are in place, the patient sits quietly for 20-40 minutes while the body “does its thing”. In that, I mean that the body responds to the tiny stimulation caused by the acupuncture needle. Even with a single puncture, the body responds with a cascade of chemical neurotransmitters triggering the body to produce endorphins, enkephalins, muscle relaxants and anti-inflamatories along with a host of other chemical responses. As I typically tell my patients “acupuncture triggers your body to make its own medicine”.

So should you know of anyone who are not responding well to conventional treatment, I welcome you to contact me with any questions about the use of acupuncture for their issue.