Vetnuus | Desember 2023 18 « BACK TO CONTENTS human medicine as to its effectiveness in the treatment of human OA (Manheimer et al. 2018, Tian et al. 2022). In dogs, the use of acupuncture as a treatment modality for chronic musculoskeletal pain has gained more acceptance over the past few decades, with a variety of postgraduate courses available. Acupuncture involves the stimulation of specific anatomical locations, termed acupuncture points, that relate to areas linked with neurovascular structures, such as nerve fibres, mechanoreceptors, small arterioles and venules, as well as lymphatics and mast cells (Dewey & Xie 2021). These points are mainly located along pathways called “meridians” that are associated with certain internal organs, body systems and major nerve pathways (Wang et al. 2010). Acupuncture points correspond with areas of increased electrical conductance or reduced electrical resistance (Reichmanis et al. 1975, Johng et al. 2002), and have been described in the dog (Yang et al. 2017). There are various forms of acupuncture, including dry-needle acupuncture, electro-acupuncture, aquapuncture, moxibustion and implantation acupuncture (Hielm-Bjorkman et al. 2001, Jaeger et al. 2006, Kapatkin et al. 2006, Li et al. 2016, Sha et al. 2016). Mechanisms of action of acupuncture The analgesic effects of acupuncture are multimodal and complex, and are believed to be exerted through local, spinal and supraspinal mechanisms (Carlsson 2002, Huntingford & Petty 2022) which are briefly summarised here. Locally, inserting a needle during acupuncture causes a microtrauma, which provides a stimulus that leads to anti-inflammatory and immune responses in the tissue (Carlsson 2002). These include increased local blood flow, the activation of peripheral sympathetic nerve fibres, the release of europeptides and endogenous opioids, and a decrease of proinflammatory cytokines (Kimura et al. 2006, Park et al. 2014b, Chen et al. 2020). At the spinal level, acupuncture has been found to reduce chemokines and inflammatory cytokine release, reducing neuronal excitability and having an anti-inflammatory effect (Liang et al. 2016, Wei et al. 2021). At the supraspinal level, within the brain, acupuncture has been found to activate descending inhibitory pain pathways (Zhang et al. 2018, Huang et al. 2021, Lyu et al. 2021). Evidence for the use of acupuncture as a treatment for OA Designing a rigorous randomised controlled trial to study the effects of acupuncture has particular challenges (Chen et al. 2019). Placebo-controlling an acupuncture clinical trial can be difficult, and therefore many trials use forms of “sham” acupuncture as control. Sham acupuncture often consists of inserting needles into non-acupuncture point areas, or inserting them very superficially, but this action itself may have a physiological effect on subjects (Kim et al. 2022). Other clinical trials use a group that receive no treatment as a control. In dogs, as many outcomes rely on owner assessment, the owner can be blinded to the treatment group if the dogs are removed from their owner while they either receive acupuncture or no treatment (Baker-Meuten et al. 2020). Several systematic reviews and meta-analyses have examined the efficacy of acupuncture in human participants with OA and have mixed conclusions (Manheimer et al. 2010, Manyanga et al. 2014, Manheimer et al. 2018, Allen et al. 2022, Tian et al. 2022). Current guidelines from the National Institute for Health and Care and Excellence (2022) in the UK advise against offering acupuncture or dry needling to manage OA in people. These guidelines cite a lack of evidence of clinical benefits and cost-effectiveness, although they do conclude that there may be some benefit to electro-acupuncture in some people and advise further research is required. Clinical trials investigating acupuncture as a treatment for canine OA are listed in Table 3. These studies include a mixture of acupuncture techniques, including dry needle acupuncture (Lane & Hill 2016, Teixeira et al. 2016, Silva et al. 2017, Baker-Meuten et al. 2020), electro-acupuncture (Kapatkin et al. 2006, Silva et al. 2017, Chomsiriwat & Ma 2019) and gold wire or gold bead implants at acupuncture points (Hielm-Bjorkman et al. 2001, Jaeger et al. 2006). The evidence behind the efficacy of acupuncture as a treatment for canine OA in these trials is mixed. Baker-Meuten et al. (2020) investigated the efficacy of acupuncture on the treatment of OA in various joints in 32 client-owned dogs over 1 year of age and over 10 kg in bodyweight. The investigators found no difference between baseline measurements versus placebo and acupuncture treatments for objective gait analysis, accelerometery or subjective orthopaedic examination, but did find a significant improvement with acupuncture versus baseline and placebo in some of the clinical metrology instrument (CMI) scores. Teixeira et al. (2016) also found improvements in CMI scores after 4 weeks of acupuncture treatments in dogs with hip dysplasia. Lane & Hill (2016) investigated the effect of a combined acupuncture and manual therapy protocol compared to no treatment in 47 dogs with lameness of various causes, including OA. The study found a short-term improvement in subjective owner assessments after two treatments 6 days apart. However, no objective outcome measurements were used, and as acupuncture was combined with other physical therapies, it cannot be concluded that the effects were due to acupuncture alone. Silva et al. (2017) concluded that the use of acupuncture alone or in combination with analgesics reduced pain and improved QOL in dogs with neurological and musculoskeletal conditions; however, the trial was not blinded, used a mixture of acupuncture, electro-acupuncture and other alternative therapies and only states the outcomes of dogs with a range of musculoskeletal disorders and not specifically OA. Studies investigating electroacupuncture in dogs with OA present mixed conclusions. Kapatkin et al. (2006) found no significant improvement in nine dogs with elbow OA treated with electro-acupuncture for 3 weeks in either owner assessment or objective gait analysis. Chomsiriwat & Ma (2019) however, did find a significant improvement in CBPI scores and hip joint range of movement in 31 dogs treated with either electro-acupuncture or laser therapy for 8 weeks compared to baseline in dogs with hip OA. This study, however, lacked a control group. Implantation of gold wire or gold beads at acupuncture points was performed on 38 and 78 dogs with hip OA, respectively (HielmBjorkman et al. 2001, Jaeger et al. 2006). Hielm-Bjorkman et al. (2001) found no significant effect, whereas Jaeger et al. (2006) found significantly greater improvements in signs of pain and mobility with subjective outcome measures in the treated group compared to control. Acupuncture –conclusions Currently available research investigating acupuncture for the alleviation of OA-associated pain does not draw firm conclusions regarding its efficacy in either veterinary or human medicine (Kapatkin et al. 2006, Manheimer et al. 2018, Baker-Meuten et al. 2020, Tian et al. 2022). There are published studies that have reported improvements in outcomes such as CMI scores and subjective outcome measurements for canine OA using different Current evidence for non-pharmaceutical, non-surgical treatments of canine osteoarthritis <<< 17
RkJQdWJsaXNoZXIy OTc5MDU=