Open Access Highly Accessed Open Badges Research article

Pain management with acupuncture in osteoarthritis: a systematic review and meta-analysis

Taru Manyanga12*, Maria Froese2, Ryan Zarychanski34, Ahmed Abou-Setta4, Carol Friesen5, Michael Tennenhouse5 and Barbara L Shay6

Author Affiliations

1 Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada

2 Surgery Rehabilitation Department, Seven Oaks General Hospital, Winnipeg, Manitoba, Canada

3 Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada

4 George & Fay Yee Center for Healthcare Innovation, University of Manitoba/Winnipeg Regional Health Authority, Winnipeg, Manitoba, Canada

5 Neil John Maclean Health Sciences Library, University of Manitoba, Winnipeg, Manitoba, Canada

6 Department of Physiotherapy, School of Medical Rehabilitation, University of Manitoba, Winnipeg, Manitoba, Canada

For all author emails, please log on.

BMC Complementary and Alternative Medicine 2014, 14:312  doi:10.1186/1472-6882-14-312

Published: 23 August 2014



The utility of acupuncture in managing osteoarthritis symptoms is uncertain. Trial results are conflicting and previous systematic reviews may have overestimated the benefits of acupuncture.


Two reviewers independently identified randomized controlled trials (up to May 2014) from multiple electronic sources (including PubMed/Medline, EMBASE, and CENTRAL) and reference lists of relevant articles, extracted data and assessed risk of bias (Cochrane’s Risk of Bias tool). Pooled data are expressed as mean differences (MD), with 95% confidence intervals (CI) (random-effects model).


We included 12 trials (1763 participants) comparing acupuncture to sham acupuncture, no treatment or usual care. We adjudicated most trials to be unclear (64%) or high (9%) risk of bias. Acupuncture use was associated with significant reductions in pain intensity (MD -0.29, 95% CI -0.55 to -0.02, I2 0%, 10 trials, 1699 participants), functional mobility (standardized MD -0.34, 95% CI -0.55 to -0.14, I2 70%, 9 trials, 1543 participants), health-related quality of life (standardized MD -0.36, 95% CI -0.58 to -0.14, I2 50%, 3 trials, 958 participants). Subgroup analysis of pain intensity by intervention duration suggested greater pain intensity reduction with intervention periods greater than 4 weeks (MD -0.38, 95% CI -0.69 to -0.06, I2 0%, 6 trials, 1239 participants).


The use of acupuncture is associated with significant reductions in pain intensity, improvement in functional mobility and quality of life. While the differences are not as great as shown by other reviews, current evidence supports the use of acupuncture as an alternative for traditional analgesics in patients with osteoarthritis.

Systematic review registration


Acupuncture; Osteoarthritis; Pain; Functional mobility; Health-related quality of life; Systematic review; Meta-analysis