Comparison of three therapeutic methods of transcutaneous electrical nerve stimulation, embedding acupuncture, and drug therapy on interleukin-6 and pain levels in patients with knee osteoarthritis
Clin Rheumatol. 2026 Jun 19. doi: 10.1007/s10067-026-08197-6. Online ahead of print.
ABSTRACT
BACKGROUND: Knee osteoarthritis (KOA) significantly impairs quality of life, yet conventional pharmacotherapy often provides inadequate symptom control with notable adverse effects. This randomized controlled trial compared thread embedding acupuncture (TEA), transcutaneous electrical nerve stimulation (TENS), and conventional drug therapy on pain, functional disability, quality of life, and serum interleukin-6 (IL-6) levels in KOA patients.
METHODS: Seventy-two patients aged 50-65 years with unilateral KOA (Kellgren-Lawrence grades 2-3) were randomly allocated to (1) single TEA session at ten acupoints (n = 24), (2) TENS therapy (50-100 Hz, 30 min, four sessions/week) for 4 weeks (n = 24), or (3) ibuprofen 400 mg twice daily for 4 weeks (n = 24). All received acetaminophen 325 mg daily. Primary outcomes were pain intensity (visual analogue scale) and serum IL-6 levels. Secondary outcomes included WOMAC index and WHOQOL-BREF scores. Assessments occurred at baseline, week 4, and week 12. Data were analyzed using repeated-measures ANOVA and ANCOVA adjusting for baseline age and IL-6.
RESULTS: At week 12, TEA showed superior pain reduction (- 1.75 [95% CI: - 2.28 to - 1.21], p < 0.001) versus TENS (- 0.72 [95% CI: - 1.25 to - 0.15], p = 0.01) and drug therapy (0.33 [95% CI: - 0.53 to 1.20], p = 0.45). Quality of life improvements were greatest with TEA (12.83 [95% CI: 6.70 to 18.95], p < 0.001) compared to TENS (5.20 [95% CI: 0.41 to 10.00], p = 0.03) and drug therapy (- 1.25 [95% CI: - 7.18 to 4.68], p = 0.68). TEA and TENS significantly reduced WOMAC scores (- 16.58 and - 11.33, both p < 0.001), unlike drug therapy. Serum IL-6 increased significantly in the TEA group (3.20 pg/mL [95% CI: 1.74 to 4.66], p < 0.001) but not in TENS or drug therapy groups.
CONCLUSION: A single TEA session provides superior and sustained improvements in pain, function, and quality of life compared to 4 weeks of TENS or drug therapy in KOA patients. Clinical benefits were associated with elevated serum IL-6, suggesting immunomodulatory mechanisms involving tissue repair pathways. TEA represents a promising integrative approach for KOA management, warranting larger trials with extended follow-up. Key Points • Pain control in knee osteoarthritis, a common disease. • Conventional treatments (such as TENS and medication) have high costs and side effects. • The use of acupuncture and embedding (TEA) can treat pain without any specific complications. • It is also important to examine IL-6 as a factor for which anti inflammatory effects were observed in our study and some studies.
PMID:42319619 | DOI:10.1007/s10067-026-08197-6