A comparison of the effects of electroacupuncture versus transcutaneous electrical nerve stimulation for pain control in knee osteoarthritis: a Bayesian network meta-analysis of randomized controlled trials

Abstract

Background

To compare the effectiveness of electroacupuncture (EA) and transcutaneous electrical nerve stimulation (TENS) for pain control in knee osteoarthritis (KOA).

Methods

Four English (MEDLINE, EMBASE, Cochrane Library and Web of Science) and three Chinese (China Science Journal Citation Report (VIP), Wanfang and China National Knowledge Infrastructure (CNKI)) language databases were searched for eligible randomized controlled trials (RCTs), comparing four approaches: EA, TENS, medication and sham/placebo controls. The primary outcome was pain intensity, measured by visual analogue scale (VAS), numeric-rating scale (NRS) or Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scale. Classic pairwise and Bayesian network meta-analyses were conducted to integrate the treatment efficacy/effectiveness through direct and indirect evidence.

Results

Thirteen studies were included. In the direct meta-analyses, there was no statistically significant overall effect of EA (mean difference (MD) −4.77, 95% confidence interval (CI) −12.51 to 2.96), while the overall effects of high-frequency transcutaneous electrical nerve stimulation (H-TENS) (MD −16.63, 95% CI −24.57 to −8.69) and medication (MD −7.12, 95% CI −12.07 to −2.17) were statistically significant. In the network meta-analyses, the relative effect of the EA and H-TENS groups (MD 5.07, 95% CI −11.33 to 21.93) on pain control did not differ. Meanwhile, H-TENS demonstrated the highest probability of being the first best treatment, and EA had the second highest probability.

Conclusion

The present analysis indicated that both EA and TENS exert significant pain relieving effects in KOA. Among the four treatments, H-TENS was found to be the optimal treatment choice for the management of KOA pain in the short-term, and EA the second best treatment option. Given that the application of TENS is recommended by various international guidelines for the treatment of KOA, EA may also represent a potentially effective non-pharmacologic therapy.

Keywords

electroacupuncture knee osteoarthritis meta-analysis pain transcutaneous electrical nerve stimulation

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References

March

Smith

Hoy

, et al. Burden of disability due to musculoskeletal (MSK) disorders. Best Pract Res Clin Rheumatol 2014; 28: 353–366.

Prieto-Alhambra

Judge

Javaid

, et al. Incidence and risk factors for clinically diagnosed knee, hip and hand osteoarthritis: influences of age, gender and osteoarthritis affecting other joints. Ann Rheum Dis 2014; 73: 1659–1664.

Lawrence

Felson

Helmick

, et al. Estimates of the prevalence of arthritis and other rheumatic conditions in the United States. Part II. Arthritis Rheum 2008; 58: 26–35.

Riddle

Kong

Fitzgerald

GK.

Psychological health impact on 2-year changes in pain and function in persons with knee pain: data from the Osteoarthritis Initiative.

Osteoarthr Cartilage 2011; 19: 1095–1101.

Nguyen

Zhang

Zhu

, et al. Increasing prevalence of knee pain and symptomatic knee osteoarthritis: survey and cohort data. Ann Int Med 2011; 155: 725–732.

Bijlsma

Berenbaum

Lafeber

FP.

Osteoarthritis: an update with relevance for clinical practice. Lancet 2011; 377: 2115–2126.

McAlindon

Bannuru

Sullivan

, et al. OARSI guidelines for the non-surgical management of knee osteoarthritis. Osteoarthr Cartilage 2014; 22: 363–388.

Zhang

Moskowitz

Nuki

, et al. OARSI recommendations for the management of hip and knee osteoarthritis, Part II: OARSI evidence-based, expert consensus guidelines. Osteoarthr Cartilage 2008; 16: 137–162.

Zeng

Yang

, et al. Electrical stimulation for pain relief in knee osteoarthritis: systematic review and network meta-analysis. Osteoarthr Cartilage 2015; 23: 189–202.

10.

Barnes

Bloom

Nahin

RL.

Complementary and alternative medicine use among adults and children: United States, 2007. Natl Health Stat Report 2008; 12: 1–23.

11.

Manheimer

Cheng

Linde

, et al. Acupuncture for peripheral joint osteoarthritis. Cochrane Database Syst Rev 2010; 1: CD001977.

12.

Chen

Zhou

, et al. Transcutaneous electrical nerve stimulation in patients with knee osteoarthritis: evidence from randomized-controlled trials. Clin J Pain 2016; 32: 146–154.

13.

Chen

Wang

Mucelli

, et al. Electro-acupuncture is beneficial for knee osteoarthritis: the evidence from meta-analysis of randomized controlled trials. Am J Chin Med 2017; 45: 965–985.

14.

Dahlberg

Holme

Hoye

, et al. A randomized, multicentre, double-blind, parallel-group study to assess the adverse event-related discontinuation rate with celecoxib and diclofenac in elderly patients with osteoarthritis. Scand J Rheumatol 2009; 38: 133–143.

15.

Higgins

Altman

Gotzsche

, et al. The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials. BMJ 2011; 343: d5928.

16.

Cipriani

Furukawa

Salanti

, et al. Comparative efficacy and acceptability of 12 new-generation antidepressants: a multiple-treatments meta-analysis. Lancet 2009; 373: 746–758.

17.

Wang

Chen

, et al. Clinical study on electroacupuncture for knee osteoarthritis. Shanghai J Acupunct Moxibustion 2017: 1111–1115. DOI: 10.13460/j.issn.1005-0957.2017.09.1111.

18.

Tang

, et al. Modern rehabilitation evaluation of efficacy of electric acupuncture at Xiyan in treating knee osteoarthritis. Shanghai J Trad Chin Med 2015; 6: 63–65.

19.

Zhou

Chen

Qian

, et al. Clinical analysis of low-frequency electro-acupuncture for knee osteoarthritis. Shanghai J Trad Chin Med 2015; 49: 56–57.

20.

Zhou

Hou

, et al. Clinical observation of moxibustion in treatment of knee osteoarthritis. Shanghai J Acup Moxi 2014; 33: 1086–1088.

21.

Cheing

Hui-Chan

Chan

KM.

Does four weeks of TENS and/or isometric exercise produce cumulative reduction of osteoarthritic knee pain?

Clin Rehabil 2002; 16(7): 749–760, http://cochranelibrary-wiley.com/o/cochrane/clcentral/articles/346/CN-00411346/frame.html

22.

Grimmer

A controlled double blind study comparing the effects of strong burst mode TENS and High Rate TENS on painful osteoarthritic knees. Aust J Physiother 1992; 38(1): 49–56, http://cochranelibrary-wiley.com/o/cochrane/clcentral/articles/858/CN-00280858/frame.html

23.

Law

Cheing

GL.

Optimal stimulation frequency of transcutaneous electrical nerve stimulation on people with knee osteoarthritis.

J Rehabil Med 2004; 36(5): 220–225, http://cochranelibrary-wiley.com/o/cochrane/clcentral/articles/266/CN-00505266/frame.html

24.

Pietrosimone

Hart

Saliba

, et al. Immediate effects of transcutaneous electrical nerve stimulation and focal knee joint cooling on quadriceps activation. Med Sci Sport Exer 2009; 41: 1175–1181.

25.

Sandelin

Harilainen

Crone

, et al. Local NSAID gel (eltenac) in the treatment of osteoarthritis of the knee. A double blind study comparing eltenac with oral diclofenac and placebo gel. Scand J Rheumatol 1997; 26: 287–292.

26.

Bruhlmann

Michel

BA.

Topical diclofenac patch in patients with knee osteoarthritis: a randomized, double-blind, controlled clinical trial. Clin Exp Rheumatol 2003; 21: 193–198.

27.

Essex

O’Connell

Bhadra Brown

Response to nonsteroidal anti-inflammatory drugs in African Americans with osteoarthritis of the knee.

J Int Med Res 2012; 40: 2251–2266.

28.

Holt

Fort

Grahn

, et al. Onset and durability of pain relief in knee osteoarthritis: pooled results from two placebo trials of naproxen/esomeprazole combination and celecoxib. Phys Sportsmed 2015; 43: 200–212.

29.

Reginster

Dudler

Blicharski

, et al. Pharmaceutical-grade chondroitin sulfate is as effective as celecoxib and superior to placebo in symptomatic knee osteoarthritis: the ChONdroitin versus CElecoxib versus Placebo Trial (CONCEPT). Ann Rheum Dis 2017; 76: 1537–1543.

30.

Salanti

Higgins

Ades

, et al. Evaluation of networks of randomized trials. Statis Methods Med Res 2008; 17: 279–301.

31.

Johnson

Bjordal

JM.

Transcutaneous electrical nerve stimulation for the management of painful conditions: focus on neuropathic pain.

Expert Rev Neurother 2011; 11: 735–753.

32.

Johnson

Martinson

M. Efficacy of electrical nerve stimulation for chronic musculoskeletal pain: a meta-analysis of randomized controlled trials. Pain 2007; 130: 157–165.

33.

Chen

Zhou

, et al. Transcutaneous electrical nerve stimulation in patients with knee osteoarthritis: evidence from randomized-controlled trials. Clin J Pain 2016; 32: 146–154.

34.

Lin

Huang

Zhu

, et al. The effects of acupuncture on chronic knee pain due to osteoarthritis: a meta-analysis. J Bone Joint Surg Am 2016; 98: 1578–1585.

35.

Shim

Jung

Kim

SS.

Effects of electroacupuncture for knee osteoarthritis: a systematic review and meta-analysis. Evidence-based complementary and alternative medicine. Ecam 2016; 2016: 3485875.

36.

MML

Leung

MCP

Poon

DMY.

The effects of electro-acupuncture and transcutaneous electrical nerve stimulation on patients with painful osteoarthritic knees: a randomized controlled trial with follow-up evaluation. J Altern Complement Med 2003; 9: 641–649.

37.

Yurtkuran

Kocagil

TENS, electroacupuncture and ice massage: comparison of treatment for osteoarthritis of the knee.

Am J Acupunct 1999; 27: 133–140.

38.

Tugwell

Wells

Shainhouse

JZ.

Equivalence study of a topical diclofenac solution (pennsaid) compared with oral diclofenac in symptomatic treatment of osteoarthritis of the knee: a randomized controlled trial. J Rheumatol 2004; 31: 2002–2012.

39.

Jung

Jang

Nam

, et al. Comparative effectiveness of oral pharmacologic interventions for knee osteoarthritis: a network meta-analysis. Mod Rheumatol 2018; 28: 1021–1028.

40.

da Costa

Reichenbach

Keller

, et al. Effectiveness of non-steroidal anti-inflammatory drugs for the treatment of pain in knee and hip osteoarthritis: a network meta-analysis. Lancet 2017; 390: e21–e33.

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