Self-administered acupressure relieves pain in probable knee OA

A randomized controlled trial (RCT) among community-dwelling middle-aged and older adults shows that self-administered acupressure (SAA) can relieve knee pain in probable knee osteoarthritis (OA).

While conventional analgesics are effective in knee OA, their use is limited due to concerns regarding potential gastrointestinal adverse effects. [JAMA 2023;330:1568-1580] Nonpharmacological interventions, such as patient education, exercise, weight loss, and physiotherapy, produce substantial but often delayed benefits and require significant changes in behaviour, which restricts their implementation. [Aust Fam Physician 2010;39:622-625] Given the limitations of conventional treatments, patients with knee OA often seek alternative complementary health approaches. [Clin Ther 2013;35:1690-1702]

In the present assessor-blinded, two-group RCT, participants were recruited from September 2019 to May 2022 through posters in the Hong Kong Polytechnic University (PolyU), community centres, and social media. All eligible participants (n=314; age, ≥50 years) were randomized 1:1 to the SAA intervention group or knee health education (KHE)–only comparison group. SAA training was provided in two 2-hour sessions by instructors who were registered Chinese medicine practitioners with ≥5 years of clinical experience and trained by experienced acupuncturists. [JAMA Netw Open 2024;7:e245830]

Participants were required to practice SAA twice daily for 12 weeks. Of those who returned their acupressure log, 79.5 percent performed acupressure ≥4 days per week during the 12-week study period. The average duration of self-practice at home was 16.5 minutes per day.

Compared with the KHE-only group, the SAA group had a significantly greater reduction in the primary endpoint of numerical rating scale (NRS) of pain scores, with a between-group difference in changes from baseline to week 4 of -0.59 points (p=0.002), to week 8 of -0.67 points (p=0.002), and to week 12 of -0.54 points (p=0.02).

“A significantly higher proportion of participants in the SAA group showed ≥2-point reduction in NRS across all study time points,” highlighted the researchers from PolyU. At week 4, 44.6 percent of SAA and 28.6 percent of KHE-only participants had a clinically significant change in NRS (p=0.003). At week 8, respective proportions were 50.3 percent vs 36.3 percent (p=0.01), and at week 12, 61.8 percent vs 49.0 percent.

Among secondary outcomes, Western Ontario and McMaster University Osteoarthritis Index scores decreased across study time points in both groups, without significant between-group difference. Compared with the KHE-only group, the SAA group performed significantly better in Timed Up and Go test at week 8, with a between-group difference in changes from baseline of -0.46 seconds (p=0.03), while there were no significant differences at weeks 4 and 12. The Short Form 6 Dimension utility score, used to assess quality of life, improved in both groups across time points, with the SAA group showing a significantly higher enhancement vs the KHE-only group at week 12 (mean difference, 0.03 points; p=0.03). “The KHE-only group also showed an improvement in knee pain and other outcome measures, which narrowed the between-group differences,” noted the researchers.

Overall, 13.4 percent of participants in the SAA group reported adverse events (AEs), all of which were mild and resolved spontaneously, except for one case of finger joint pain, which led to discontinuation. “The most frequently reported AE was finger joint pain, likely due to prolonged or improper pressing of acupoints, which was also found in other studies. To enhance SAA safety, future studies should promote the use of acupressure rods to prevent finger overuse and overexerting pressure on acupoints,” advised the researchers. [Acupunct Med 2020;38:75-85; J Altern Complement Med 2016;22:396-403]