A Randomized Controlled Trial Comparing Ultrasound-Guided Genicular Nerve Block Combined with Acupuncture versus Acupuncture Alone for Patients with Knee Osteoarthritis
Keywords:
acupuncture, genicular nerve block, knee osteoarthritis, pain managementAbstract
Background: Knee osteoarthritis (OA) is a prevalent cause of pain and disability, especially among the elderly. Standard treatments include pharmacological interventions and non-pharmacological methods like acupuncture. Combining genicular nerve block (GNB) with acupuncture may enhance pain relief and functional outcomes. This study compares the efficacy of GNB combined with acupuncture versus acupuncture alone in knee OA patients. Methods: A randomized controlled trial was conducted involving 82 participants with knee OA. Participants were randomized into two groups: 41 received GNB combined with acupuncture, and 41 received acupuncture alone. Pain was assessed using the visual analog scale (VAS), functional status with the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and quality of life with the 36-Item Short Form Health Survey questionnaire (SF-36). Assessments were conducted at baseline, and at weeks 2, 5, 10, and 12. Results: The GNB and acupuncture group experienced greater reductions in pain and WOMAC scores compared to the acupuncture group. By week 12, the GNB and acupuncture group reduced VAS scores from 5.45 to 1.80, while the acupuncture group showed a reduction from 5.92 to 2.50 (P < 0.05). WOMAC scores improved more significantly in the GNB and acupuncture group compared to the acupuncture group. Both groups reported high satisfaction, with no significant differences in quality of life. Conclusion: GNB combined with acupuncture offers superior pain relief and functional improvement compared to acupuncture alone in patients with knee OA, making it a promising non-surgical treatment option.
References
Mora JC, Przkora R, Cruz-Almeida Y. Knee osteoarthritis: pathophysiology and current treatment modalities. J Pain Res. 2018;11:2189-96.
Pereira D, Peleteiro B, Araújo J, Branco J, Santos RA, Ramos E. The effect of osteoarthritis definition on prevalence and incidence estimates: a systematic review. Osteoarthritis Cartilage. 2011;19:1270-85.
Cross M, Smith E, Hoy D, et al. The global burden of hip and knee osteoarthritis: estimates from the Global Burden of Disease 2010 study. Ann Rheum Dis. 2014;73:1323-30.
The Royal College of Orthopaedic Surgeons of Thailand. Clinical practice guideline of knee osteoarthritis. Bangkok; 2011.
Jevsevar DS. Treatment of osteoarthritis of the knee: evidence-based guideline, 2nd edition. J Am Acad Orthop Surg. 2013;21:571-6.
Kehlet H, Dahl JB. Anaesthesia, surgery, and challenges in postoperative recovery. Lancet. 2003;362:1921-8.
Santaguida PL, Hawker GA, Hudak PL, et al. Patient characteristics affecting the prognosis of total hip and knee joint arthroplasty: a systematic review. Can J Surg. 2008;51:428-36.
Qudsi-Sinclair S, Borrás-Rubio E, Abellan-Guillén JF, Del Rey MLP, Ruiz-Merino G. A comparison of genicular nerve treatment using either radiofrequency or analgesic block with corticosteroid for pain after a total knee arthroplasty: a double-blind, randomized clinical study. Pain Pract. 2017;17:578-88.
Kim DH, Choi SS, Yoon SH, et al. Ultrasound-guided genicular nerve block for knee osteoarthritis: a double-blind, randomized controlled trial of local anesthetic alone or in combination with corticosteroid. Pain Physician. 2018;21:41-52.
Selfe TK, Taylor AG. Acupuncture and osteoarthritis of the knee: a review of randomized, controlled trials. Fam Community Health. 2008;31:247-54.
Manheimer E, Cheng K, Linde K, et al. Acupuncture for peripheral joint osteoarthritis. Cochrane Database Syst Rev. 2010;2010:CD001977.
White A, Hayhoe S, Hart A, Ernst E. Adverse events following acupuncture: prospective survey of 32000 consultations with doctors and physiotherapists. BMJ. 2001;323:485-6.
MacPherson H, Thomas K, Walters S, Fitter M. The York acupuncture safety study: prospective survey of 34000 treatments by traditional acupuncturists. BMJ. 2001;323:486-7.
Melchart D, Weidenhammer W, Streng A, et al. Prospective investigation of adverse effects of acupuncture in 97733 patients. Arch Intern Med. 2004;164:104-5.
Hunter DJ, Bierma-Zeinstra S. Osteoarthritis. Lancet. 2019;393:1745-59.
Choi WJ, Hwang SJ, Song JG, et al. Radiofrequency treatment relieves chronic knee osteoarthritis pain: a double-blind randomized controlled trial. Pain. 2011;152:481-7.
Shanahan EM, Robinson L, Lyne S, et al. Genicular nerve block for pain management in patients with knee osteoarthritis: a randomized placebo-controlled trial. Arthritis Rheumatol. 2023;75:201-9.
Vas J, Perea-Milla E, Méndez C, et al. Efficacy and safety of acupuncture for chronic uncomplicated neck pain: a randomised controlled study. Pain. 2006;126:245-55.
Bijlsma JWJ, Berenbaum F, Lafeber FPJG. Osteoarthritis: an update with relevance for clinical practice. Lancet. 2011;377:2115-26.
Hayek SM, Shah A. Nerve blocks for chronic pain. Neurosurg Clin N Am. 2014;25:809-17.
Olsen MF, Bjerre E, Hansen MD, Tendal B, Hilden J, Hróbjartsson A. Minimum clinically important differences in chronic pain vary considerably by baseline pain and methodological factors: systematic review of empirical studies. J Clin Epidemiol. 2018;101:87-106.e2.
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