Is acupuncture at ST (Stomach) 34 and 35 sites effective for treating knee pain?

Acupuncture at ST 34 and 35 Sites for Knee Pain

Acupuncture at ST 34 and 35 sites is not recommended for treating knee pain due to osteoarthritis, as current clinical guidelines do not support acupuncture as an effective therapy for knee osteoarthritis. 1

Evidence from Clinical Guidelines

The American Academy of Orthopaedic Surgeons (AAOS) clinical practice guideline explicitly states that acupuncture is not recommended for knee osteoarthritis treatment 1. This strong recommendation against acupuncture is based on the lack of effectiveness, not on potential harm. The guideline notes that most studies regarding acupuncture were not statistically significant, and much of the evidence was not clinically significant.

Similarly, the American Academy of Orthopaedic Surgeons' 2009 guideline on treatment of osteoarthritis of the knee (nonarthroplasty) was unable to make a recommendation for or against acupuncture as an adjunctive therapy for pain in patients with symptomatic OA of the knee 1. Their meta-analysis suggested that the reported effects of acupuncture on pain depend on study design and conduct, with the largest effects found in studies that did not employ blinding and the smallest effects in studies that employed proper blinding.

Specific Points ST 34 and 35

While some research has examined these specific acupuncture points for knee pain, the evidence does not support their effectiveness:

• ST 34 (Yanglingquan/gall bladder meridian point 34) and ST 35 (Dubi/stomach meridian point 35) are commonly used in Traditional Chinese Medicine for knee joint pain, known as the "Bi" syndrome 1
• These points are often used along with other acupuncture points in treatment protocols for knee pain 1

Current Recommended Treatments for Knee Pain

Instead of acupuncture, current guidelines recommend:

1. Non-pharmacological approaches:

   • Self-management programs
   • Strengthening exercises
   • Low-impact aerobic exercise
   • Neuromuscular education 1
   • Weight loss for patients with BMI ≥25 kg/m² 1

2. Pharmacological treatments:

   • Oral or topical nonsteroidal anti-inflammatory drugs (NSAIDs)
   • Acetaminophen (though evidence is limited)
   • Duloxetine as an alternative or adjunctive therapy 1

3. Injections:

   • Intra-articular corticosteroid injections for persistent pain 1
   • Hyaluronic acid injections are not recommended 1

Recent Research on Acupuncture for Knee Pain

Despite the negative recommendations in clinical guidelines, some recent research suggests limited benefits:

• A 2016 meta-analysis found that acupuncture can improve short-term and long-term physical function, but appears to provide only short-term pain relief in patients with chronic knee pain due to osteoarthritis 2

• A 2022 overview of systematic reviews found statistically significant differences in pain intensity and knee function in favor of acupuncture versus control interventions in patients with knee OA in the short term, but these differences were not clinically important 3

Common Pitfalls in Acupuncture for Knee Pain

1. Relying on unblinded studies: The apparent effects of acupuncture may be due to placebo effects, as studies with proper blinding show minimal benefits 1

2. Focusing only on traditional point selection: Some research suggests that palpation to identify specific pain-generating areas may be more effective than using standardized acupuncture points 4

3. Expecting long-term pain relief: Even studies showing some benefit indicate that pain relief is typically short-term rather than sustained 2

In conclusion, while acupuncture at ST 34 and 35 sites is a common traditional approach for knee pain, current clinical guidelines do not support its use for knee osteoarthritis. Patients with knee pain should instead be directed toward evidence-based treatments including exercise, weight management when appropriate, and pharmacological options such as NSAIDs when indicated.