Acupuncture reduces knee pain, but so does placebo

Last Updated: 2006-07-05 15:36:25 -0400 (Reuters Health)

NEW YORK (Reuters Health) - Acupuncture is effective in relieving osteoarthritis knee pain, new research suggests, but placebo acupuncture appears to also do the job.

As reported in the Annals of Internal Medicine, acupuncture was 53.1-percent successful in treating symptoms of knee osteoarthritis. However, a sham procedure that looked like acupuncture, but provided no actual benefit, was a close second with a success rate of 51.0 percent.

Still, the authors are reluctant to dismiss acupuncture as a treatment for knee osteoarthritis. The findings support a role for acupuncture as part of the treatment of "patients with pain and functional limitations due to osteoarthritis of the knee, even if the mechanisms of its effects remain unclear," they write. Acupuncture could add to the effects of more conservative therapy and reduce the need for pain medications.

The findings stem from a study of more than 1,000 patients who had pain due to osteoarthritis for at least six months. In addition to undergoing six physiotherapy sessions and receiving antiinflammatory drugs as needed, the patients were randomly assigned to undergo 10 sessions of traditional Chinese acupuncture, 10 sessions of sham acupuncture, or 10 physician visits within a 6-week period. If the treatment was viewed as successful, the patient could receive five additional sessions or visits.

The sham acupuncture consisted of minimal depth needling at points away from recognized traditional Chinese acupuncture sites, lead author Dr. Hanns-Peter Scharf, from the University of Heidelberg in Germany, and colleagues note. Successful treatment was defined as a 36 percent or greater improvement in osteoarthritis index scores.

As noted, the two acupuncture treatments achieved success rates of around 52 percent each. By contrast, the success rate with conservative therapy was just 29.1 percent. Compared with conservative therapy, the two forms of acupuncture were roughly 74 percent more likely to be effective.

More study is needed to determine if the mechanism of acupuncture's effect is linked to the physiologic effects of needling, to more intense contact with the health provider or to a placebo effect, the authors conclude.

SOURCE: Annals of Internal Medicine, July 4, 2006.

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High fever in children warrants work up for bacterial infection

Last Updated: 2006-07-05 16:10:55 -0400 (Reuters Health)

By Megan Rauscher

NEW YORK (Reuters Health) - Children with a very high fever, defined as a rectal temperature of 106 degrees Fahrenheit or higher, have a heightened risk for serious bacterial infection and for viral illness, or both, report clinicians in the current issue of Pediatrics.

Among 103 children younger than age 18 who were seen at an emergency department with high fevers over a 2-year period, 20 (18.4 percent) had confirmed bacterial infections and 22 (21.4 percent) had confirmed viral infections. One child was infected with both types of pathogens.

"Children with underlying illnesses were at higher risk for bacterial infections," Dr. Barbara W. Trautner from Baylor College of Medicine in Houston commented to Reuters Health. Serious bacterial infection occurred 7 of 19 (36.8 percent) children with an underlying illness, compared with 13 of 84 (15.5 percent) children without an underlying illness.

Other than the presence of a preexisting medical condition, there were no factors that predicted the presence of a serious bacterial infection versus a viral infection, Trautner and colleagues report.

Specifically, the children's white blood cell count, which normally increases when an infection is present, did not help distinguish between bacterial and viral infection. "A near-normal white blood cell count may have led to failure to prescribe antibiotics to three children with serious bacterial infections," they note.

Likewise, viral symptoms were not reliable in establishing the cause of the fever, because viral symptoms overall were associated with a decreased risk of serious bacterial infection, but diarrhea was associated with an increased risk."

"The take home message," said Trautner, is that children who arrive in the "emergency department with a fever of 106F or higher are at high risk for a bacterial infection, and the physician should consider antibiotic treatment for all such children who do not have a confirmed viral infection."

Source: Pediatrics, July 2006.

Copyright © 2006 Reuters Limited. All rights reserved. Republication or redistribution of Reuters content, including by framing or similar means, is expressly prohibited without the prior written consent of Reuters. Reuters shall not be liable for any errors or delays in the content, or for any actions taken in reliance thereon. Reuters and the Reuters sphere logo are registered trademarks and trademarks of the Reuters group of companies around the world.