| Objective:To observe the curative effect of using pain-sensitive points to treat knee osteoarthritis;to analyze the correlation between patient’s expectations and the clinical effect of acupuncture;to explore whether the patient’s expectations has an effect on the change of pain threshold.Methods:201 patients with knee osteoarthritis who met the inclusion criteria from Chengdu university of TCM were randomly assigned to different groups: high sensitive group ﹑ non/low sensitive group and waiting list.13 fixed acupoints((HEDING(EX-LE2),NEIXIYAN(EX-LE4),DUBI(ST 35),XUEHAI(SP 10),LIANGQIU(ST 34),YINLINGQUAN(SP 9),YANGLINGQUAN(GB 34),ZUSANLI(ST 36),WEIZHONG(BL 40),YINGU(KI 10),XIGUAN(LR 7),QUQUAN(LR 8),WEIYANG(BL 39))and local tender points of knee joint were measured by a Von Fery detector.After the measurement,the pain threshold was expressed as means of the values,the data of each point was sorted from high to low.The five acupoints with the lowest pain threshold were selected for the high sensitive group,and the five acupoints with the highest pain threshold were selected for non / low sensitive group.Acupuncture was performed until Deqi,manipulated needles every 15 min for 30 min,for a total of 2 times.Acupuncture treatment was performed once every other day,three times a week for 4 weeks.The study period was 16 weeks,including baseline,treatment for 4 weeks and follow-up for 12 weeks.The Western Ontario and McMaster Universities Osteoarthritis index(WOMAC score)and Short Form Health(Survey-12)were evaluated at baseline,4 weeks and 16 weeks after admission.And the pain threshold of the points were evaluated at baseline and 4 weeks after admission.After the follow-up,the data were collected and collated,and the expectations value scale filled out by the patients in the baseline period was evaluated.Patients who completed the whole study were regrouped according to the different expected values.The high and low expectation groups were analyzed by SPSS software as follows:(1)Comparing the differences of the clinical improvement at knee osteoarthritis between high and low expectation groups at baseline,4 weeks and 16 weeks after admission,to observe whether acupuncture treatment by using pain-sensitive points can relief the clinical symptoms of the patient,and improving their quality of life;(2)Comparing the difference of clinical improvement between the patients selected high sensitive points in the high expectation group and low expectation group,the patients selected non / low sensitive points in the high expectation group and low expectation group at the baseline,4 weeks and 16 weeks after admission,to explore whether the expected value will affect the curative effect of acupuncture on knee osteoarthritis;(3)After treatment,comparing there was any difference in the change rate of pain threshold between the patients selected high sensitive points in the high expectation group and low expectation group,the patients selected non / low sensitive points in the high expectation group and low expectation group.To explore whether the expected value has an effect on the change of rate of pain threshold;(4)To analyze the factors affecting the expectation of patients with knee osteoarthritis.Results:(1)Clinical effect of needling pain-sensitive points on knee osteoarthritis.(1)After treatment,acupuncture could significantly improve the total WOMAC score of patients with knee osteoarthritis in both high and low expectation groups(P < 0.05);WOMAC scale pain score,stiffness score and daily activity difficulty score were significantly decreased(P < 0.05).(2)After treatment,acupuncture can significantly improve the quality of life of patients in both high and low expectation groups;The score of physical component Scale(PCS)and Mental component Scale(MCS)of the patients were significantly higher than baseline(P < 0.05).However,it was found that PCS still increased slowly in the low expectation group when PCS decreased slightly in the high expectation group,and MCS decreased in both groups(P < 0.05).(2)Effect of different expectation value on acupuncture curative effect.(1)Whether the high sensitive point or the non/low sensitive point was selected as the acupuncture intervention point,the baseline period was compared with that of 4 weeks in the group and 4 weeks in the group and 16 weeks in the group.There was no significant difference in the total score of WOMAC scale and the scores of pain,stiffness and difficulty of daily activity between the high and low expectation groups(P > 0.05).However,during treatment,the change of total WOMAC score in the low expectation group was faster than that in the high expectation group(P < 0.05),but the result high expectation group is better than low expectation group.but there was no significant difference in the other indexes(P > 0.05),and there was no significant difference in the change rate of the other indexes between the high expectation group and the low expectation group(P > 0.05).(2)Whether the highly sensitive point or the non/low sensitive point was selected as the acupuncture intervention point,the baseline period was compared with 4 weeks after admission,and 4 weeks and in 16 weeks after admission.There was no significant difference in PCS and MCS between high and low expectation groups(P > 0.05).(3)After treatment,the local pain threshold of acupuncture points in patients with knee osteoarthritis changed,compared with the baseline period,the pain thresholds of acupoints in high and low expectation groups changed,and the pain domain values of high sensitivity acupoints showed an upward trend.There was a downward trend in the pain domain of non/low sensitive points,but there was no significant difference in the change of pain threshold between high and low expectation groups(P > 0.05).(3)Factors influencing the expectation of patients with knee osteoarthritis.By using Logistic regression analysis,it was found that only PCS and MCS had an effect on the expected value of acupuncture and moxibustion(P < 0.05).The higher the baseline PCS,the lower the expectation;the higher the MCS,the higher the expectation.Conclusion:(1)Chosen with non/low sensitive points as a treatment method,high expectations can mediate more rapid symptom relief in patients with knee osteoarthritis in a certain extent,but when selecting high sensitive points as acupuncture method,The level of expectation has no effect on the changes of pain,stiffness and life difficulties in patients with knee osteoarthritis,but the improvement of quality of life in patients with high expectations is better than that the patients with low expectations.The expected value had no effect on the change of pain threshold in acupuncture points.This shows that the high expectation value may affect the curative effect of acupuncture on knee osteoarthritis,but the proportion of this effect is small,when the highly sensitized points are selected as the treatment method,The influence of expectation effect on acupuncture curative effect became weaker and weaker.by observing the change of pain threshold of those points,it was not found that expectation had an effect on it.Therefore,this experiment has preliminarily proven that the non-specific effect occupies a certain position in the curative effect of acupuncture,but its specific effect is in improving the symptoms and quality of life of patients with knee osteoarthritis.The selection of acupoints plays a major role in the specific effect,and is not affected by the expectation.(2)Acupuncture by using pain-sensitive point is effective in the treatment of knee osteoarthritis.acupuncture can significantly relief the degree of the pain,stiffness and daily life difficulties of patients with knee osteoarthritis,and can improve their quality of life.And acupuncture has a certain persistent effect on alleviating the clinical symptoms of patients with knee osteoarthritis in a short period of time.(3)In this study,the expectations of patients with knee osteoarthritis were affected by their quality of life. |
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