hysical M f P ed l o ic a in n r e u & o R J International Journal of Physical l e a h n a o b i Ibrahim et al., Int J Phys Med Rehabil 2015, 3:2 t i l a ISSN: 2329-9096i t a n r t i e o t n 10.4172/2329-9096.1000259 n I Medicine & Rehabilitation DOI: Research Article Open Access Acupuncture versus Homeopathy as a Complementary Therapy in Patients with Knee Osteoarthritis Soha E Ibrahim1*, Abeer K el Zohiery1, Sameh A Mobasher2 , Amina Badr Eldin2, Mouchira A Mohamed3 and Aziza A Abdalla3 1Physical Medicine and Rehabilitation Department, Ain Shams University, Egypt 2Internal Medicine Department - Rheumatology Division, Ain Shams University, Egypt 3Complementary Medicine Department, National Research Center, Cairo, Egypt *Corresponding author: Soha Eldessouki Ibrahim, Physical Medicine and Rehabilitation Department, Ain Shams University, Egypt, Tel: 20226831474; E-mail: [email protected] Received date: 07 November 2014; Accepted date: 23 February 2015; Published date: 27 February 2015 Copyright: © 2015 Ibrahim SE, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Abstract Background: Osteoarthritis of the knee is a major cause of disability with treatment focused only on control of symptoms. The conservative non surgical management of knee osteoarthritis is to control the signs and symptoms. However, knee replacements are common for knee osteoarthritis. Despite the popularity of both acupuncture and homeopathy, evidence of their efficacy for treatment of osteoarthritis remains controversy. Aim of the work: To assess the efficacy of Acupuncture compared with Homeopathy and with the usual conservative treatment (analgesics and physiotherapy) in patients with knee osteoarthritis. Patients and Methods: Seventy-five patients who had had chronic pain for at least 6 months due to osteoarthritis of the knee (American College of Rheumatology [ACR] criteria and Kellgren-Lawrence score of 2) were admitted to the study. During the study, all of the subjects continued on their conservative therapy, which remained unchanged throughout the study. The subjects were randomly divided into three groups. Group I (Acupuncture group): Included 25 patients who were subjected to acupuncture at the standardized acu-point stimulation treatment without electrical stimulation. Sessions were done twice weekly from base line visit to week six. Group II (Homeopathy group): Included 25 patients who were given oral doses of homeopathic remedies that were commonly used for the treatment of osteoarthritis (Arnica Montana, Ruta graveolans and Rhus toxicodendron). Group III (Control group): Included 25 patients who continued only on their pre-study medications. Pain intensity on visual analog scale (VAS), the Health Assessment Questionnaire (HAQ) score and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score were recorded for each patient before the beginning of treatment, during each visit and at the end of the sessions. The results were statistically analyzed. Results: Pain was significantly improved on both VAS and pain subscale of the WOMAC in group I. Also, the number of tender points decreased significantly and there was a significant decrease in the number of patients receiving analgesics for pain control at the end of the study (p<0.05). In addition, a statistically significant improvement in knee function was detected (p<0.05) on the total WOMAC score for knee osteoarthritis and both the function and stiffness subscales of the WOMAC, in addition a statistically significant decrease in knee swelling (knee circumference) was detected in group I. There was also a significant increase in patient quality of life assessed by the HAQ score for group I and this gain was significantly greater than the gain in the control group. There was a statistically significant improvement in the total WOMAC score, (both VAS and pain subscale of the WOMAC) and a significant reduction in the number of tender points in group II. Moreover, a significant decrease in the number of patients receiving analgesics for pain control was reported in this group (p<0.05). In addition, the improvement of pain and function was statistically greater (p<0.05) in comparison to the control group (group III). Conclusions: Both Acupuncture and Homeopathy were effective in reducing pain and improving function of the knee compared to the usual care group but acupuncture was significantly more effective than homeopathy. Moreover, Acupuncture significantly decreased the knee circumference (swelling) while homeopathy and usual care did not significantly decrease the swelling. Keywords: Osteoarthritis; Knee; Acupuncture; Homeopathy increase not only with aging of the population but particularly those who are aging and suffer from obesity [1].The hip and knee are two Introduction commonly affected joints, having a significant impact on walking and other daily activities. The prevalence of OA is on the rise, and this Osteoarthritis (OA) is the most common type of arthritis in trend is expected to continue [2]. humans. It is a major cause of pain and disability and has significant consequences for public health. The burden of OA is expected to Int J Phys Med Rehabil Volume 3 • Issue 2 • 1000259 ISSN:2329-9096 JPMR, an open access journal Citation: Ibrahim SE, Zohiery AK, Mobasher SA, Eldin AB, Mohamed MA, et al. (2015) Acupuncture versus Homeopathy as a Complementary Therapy in Patients with Knee Osteoarthritis. Int J Phys Med Rehabil 3: 259. doi:10.4172/2329-9096.1000259 Page 2 of 7 Optimal management of patients with OA emphasizes conservative, coagulopathy, pregnancy, previous acupuncture treatment for nonsurgical strategies, combining non-pharmacological and osteoarthritis, had undergone knee surgery or intra-articular steroid pharmacological therapies [3]. The pharmacological modalities of injection within four weeks preceding the study,suffered arthritis due treatment including acetaminophen, oral NSAIDs, topical NSAIDs, to other inflammatory conditions or experienced other medical causes tramadol and intra-articular injections of corticosteroids. of pains rather than knee OA. Unfortunately, the pharmacologic therapies used in treatment of OA may often cause unwanted and dangerous side effects [4]. the non- All patients completed the following baseline evaluations pharmacological modalities include: education, physical activities (e.g aerobic, strengthening, flexibility and aquatic exercise ) , weight Full medical history and thorough clinical examination (general, reduction, walking aids, footwear, physical therapy(e.g. specific systemic and musculoskeletal). Special emphasis as given to knee isometric , isotonic, stabilization and plyometric training ,manual and examination and knee circumference. soft tissue mobilizations , electrotherapeutic modalities, deep heat) and The body mass index (BMI): was calculated for each patients using complementary therapies like Tai Chi ,Pilates, Yoga and Alexander the following equation: BMI= Weight\ (Height) 2 with weight in programs as well as acupuncture [5]. kilograms and height in meters [14]. Many studies have documented that acupuncture has a beneficial Standard laboratory investigations were done including: complete effect when treating many diseases and painful conditions. Therefore blood picture (CBC), Erythrocyte sedimentation rate [ESR], C-reactive acupuncture is proposed to be a useful complementary therapy and protein [CRP], kidney function (BUN- serum creatinine), liver may replace generally accepted pharmacological intervention [6]. It is enzymes (AST-ALT), complete lipid profile, and urine analysis. proposed that acupuncture produces its effects by the conduction of electromagnetic signals at a greater-than-normal rate, thus aiding the Plain X-ray of both knees (antro-posterior and lateral views) to activity of pain-killing biochemicals , such as endorphins and immune determine the grade of knee osteoarthritis [13]. system cells at specific sites in the body [7]. In addition, acupuncture All the patients continued on the same dose and type of analgesic may alter brain chemistry by changing the release of neurotransmitters medications used before the study (including paracetamol or NSAID) and neurohormones and affecting the parts of the central nervous according to patients` needs. After consent, the patients were system related to sensation and involuntary body functions, such as randomly assigned to the following group. immune reactions and processes whereby a person’s blood pressure, Needle blood flow, and body temperature are regulated [8]. Acupoints Location manipulation Homeopathy is a system of medicine which involves treating the With knee flexed, point at lower border 0.5 to 1 cun individual with healthy substances, emphasizing natural foods as well Stomach 35 as specific supplements in tablet form , with the aim of triggering the of patella,in a depression lateral to the obliquely in medial (ST35) (Dubi) patellar ligament (the point is the direction body’s natural system of healing [9]. Homeopathy is based on the lateral foramen of the patella) principle that an illness can be treated ‘like with like’, that is, a substance which causes symptoms when taken in large doses, can be Stomach 36 3 cun below ST35, one finger breadth Vertical 1 to1.5 cun from anterior crest of tibia.,on tibilalis used in small amounts