The researchers base their findings on 90 patients with knee osteoarthritis, who were referred for group acupuncture to two knee pain clinics in St Albans, Hertfordshire, in 2008 and subsequently monitored for two years.

The clinics were set up in 2008 for NHS patients, and run in two GP practices by specially trained acupuncture nurses, to see whether this could improve care, while reducing costs, and offer a viable alternative to referrals for expensive knee replacement surgery (http://youtu.be/HX3ziJ_DNCQ?hd=1).

This type of surgery works well, and provides value for money, say the authors. But it is not suitable for everyone, and as many as one in seven patients experience severe pain a few years after the procedure.

It also costs £5,000 a pop, and knee osteoarthritis is common, causing significant pain in 17% of the UK population over the age of 50, they add.

Out of 114 patients who were offered acupuncture for osteoarthritic knee pain in 2008, 90 accepted and were treated in the clinics. Their average age was 71. All the patients referred to the clinics had severe symptoms -- constant pain, including at night, and inability to walk far -- and would have been eligible for surgery.

Fifty patients said they would be prepared to have surgery; four said they would only have the operation as a last resort; and 29 said they did not want surgery.

They were given acupuncture once a week for a month after which the frequency was reduced to a session every six weeks.

Forty one patients were still attending the clinics after a year, and 31 were still receiving treatment after two years. Each patient received an average of 16.5 treatments.

A validated score (MYMOP), used to measure symptom control, functional capacity, and wellbeing, showed clinically significant improvements in pain levels, stiffness, and functional capacity after one month of treatment. These improvements continued throughout the two year monitoring period, as assessed by MYMOP at six monthly intervals.

Based on the assumption that only two thirds of patients would take up an offer of acupuncture, the authors calculate that the service could save the NHS around £100,000 a year. Each treatment costs the NHS £20.

The authors also looked at the rates of total knee replacements for the three neighbouring commissioning groups after the service had been introduced.

They found that the group that had commissioned the service, which includes 13 general practices serving 180,000 patients, had the lowest rate, and that this was 10% lower than one of the other groups by 2011.

A second small study in the journal shows that group acupuncture was popular with both nurses and patients, and in an accompanying podcast (http://snd.sc/NaCdbu), a patient who underwent the treatment describes what a difference it has made to her life.

Note: If no author is given, the source is cited instead.

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