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Physicians: .25 AMA PRA Category I CreditsTM
Family Physicians: .25 Prescribed credits
Nurse Practitioners: .25 Contact hours

Release Date: October 15, 2014
Expiration Date: October 15, 2015

Estimated Completion Time: 15 minutes

There is no fee for this activity.

To Receive Credit

In order to receive your certificate of participation, you should read the information about this activity, including the disclosure statements, review the entire activity, take the post-test, and complete the evaluation form. You may then follow the directions to print your certificate of participation. To begin, click the CME icon above.

Program Overview

Learning Objectives

Upon successful completion of this educational program, the reader should be able to:

1. Discuss the significance of this article as it relates to your clinical practice.
2. Be able to apply this knowledge to your patient's diagnosis, treatment and management.

Faculty Information

Alan Ehrlich, MD
Assistant Professor in Family Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, USA; Executive Deputy Editor, DynaMed, Ipswich, Massachusetts, USA

Michael Fleming, MD, FAAFP
Assistant Clinical Professor of Family Medicine and Comprehensive Care, LSU Health Science Center School of Medicine, Shreveport, Louisiana, USA; Assistant Clinical Professor of Family Medicine, Department of Family and Community Medicine, Tulane University Medical School, New Orleans, Louisiana, USA; Chief Medical Officer, Amedisys, Inc. & Antidote Education Company


Dr. Ehrlich, Dr. Fleming, DynaMed Editorial Team members, and the staff of Antidote Education Company have disclosed that they have no relevant financial relationships or conflicts of interest with commercial interests related directly or indirectly to this educational activity.

No commercial support has been received for this activity.

Accreditation Statements

ACCME: This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education through the joint sponsorship of Antidote Education Company and EBSCO Publishing. Antidote is accredited by the ACCME to provide continuing medical education for physicians. Antidote Education Company designates this enduring activity for a maximum of 0.25 AMA PRA Category 1 CreditsTM. Physicians should only claim credit commensurate with the extent of their participation in the activity.

AAFP: This enduring material activity, DynaMed EBM Focus Volume 9, has been reviewed and is acceptable for up to 15.25 Prescribed credits by the American Academy of Family Physicians. AAFP certification begins March 5, 2014. Term of approval is for one year from this date. Each EBM Focus is approved for .25 Prescribed credits. Credit may be claimed for one year from the date of each update. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

AANP: This program is approved for 0.25 contact hour(s) of continuing education by the American Association of Nurse Practitioners. This program was planned in accordance with AANP CE Standards and Policies and AANP Commercial Support Standards.

Program ID: 1405237V

Last week 570 journal articles were evaluated via DynaMed's Systematic Literature Surveillance and summaries of 202 articles were added to DynaMed content.

Based on criteria for selecting "articles most likely to change clinical practice," one article was selected by the DynaMed Editorial Team.

Needle or Laser Acupuncture Does Not Improve Chronic Knee Pain in Patients with Knee Osteoarthritis
Reference: JAMA 2014 Oct 1;312(13):1313 (level 1 [likely reliable] evidence)

Acupuncture has been advocated for management of various painful conditions. However, high quality evidence supporting its use in patients with chronic knee pain has been lacking. A guideline from the American Academy of Orthopaedic Surgeons (AAOS) states that acupuncture cannot be recommended in patients with symptomatic osteoarthritis of the knee, due to lack of efficacy (AAOS 2013 May 18 PDF). Similarly, a guideline from the American College of Rheumatology (ACR) recommends traditional Chinese acupuncture only for patients with chronic moderate to severe pain who are candidates for total knee arthroplasty but are unwilling to have a procedure, have comorbid conditions, or are taking concomitant medication that contraindicates surgery (Arthritis Care Res (Hoboken) 2012 Apr;64(4):465-4 full-text). A recent randomized trial compared 2 forms of acupuncture (needle or laser) vs. sham acupuncture or no acupuncture in 282 patients ≥ 50 years old with chronic knee pain.

The trial enrolled patients who had knee pain for > 3 months, knee pain on most days with severity score ≥ 4 on numeric rating scale (range 0-10), and morning stiffness < 30 minutes, which is consistent with a clinical diagnosis of osteoarthritis. Patients received the intervention 1-2 times weekly for a total of 12 weeks. Comparing needle or laser acupuncture vs. sham at 12 weeks, there were no significant differences in knee pain, pain upon walking or standing, physical function, quality of life, or mental or physical health. These findings were consistent when assessed at 1 year.

The term ´┐Żacupuncture´┐Ż may refer to several different types of interventions, making it difficult to make a general conclusion about its efficacy in patients with degenerative joint disease of the knee. The findings of this new high-quality trial are consistent with another high-quality trial that also found no significant improvement in pain with traditional Chinese acupuncture vs. a sham acupuncture control (Arthritis Care Res (Hoboken) 2010 Sep;62(9):1229 full-text). In addition, a Cochrane review identified 16 trials evaluating patients with osteoarthritis (12 of which included only patients with knee osteoarthritis), and found that clinically significant improvement in pain and function with acupuncture only occurred in comparison to wait-list control, suggesting a placebo effect (Cochrane Database Syst Rev 2010 Jan 20;(1):CD001977). Based on the evidence to date, neither needle nor laser acupuncture appear effective for reducing chronic knee pain in patients with knee osteoarthritis.

For more information, see the Degenerative joint disease of the knee topic in DynaMed.

Earn CME Credit for reading this e-Newsletter. For more information on this educational activity, see the CME sidebar.

DynaMed Events

American Academy of Family Physicians Conference: October 21-25, 2014

Representatives will be available at the American Academy of Family Physicians Assembly in Washington, District of Columbia to discuss peer review, mobile access, and free trial information. Stop by to receieve a complementary trial to PEMSoft mobile!

Executive Deputy Editor Alan Ehrlich, MD, will be attending and will also be presenting on Medical Marijuana: What You Need To Know on Friday at 9:15am and 2:45pm.

Visit the AAFP website to learn more about the event and for registration information.

If you would like to meet with a DynaMed representative at any of our conferences, please contact us at DynaMedCommunity@ebscohost.com.

DynaMed Careers

The DynaMed editorial team is seeking specialist editors in the following fields: ENT, Gastroenterology, Hematology, Nephrology, Ophthalmology, Orthopedics, Surgery, Vascular.

If interested, please send a recent copy of your CV to Rachel Brady at rbrady@ebsco.com.

PEMSoft Mobile

PEMSoft Now Available For iPhone, iPad, and Android Devices

The PEMSoft Mobile app, a pediatric evidence-based point-of-care medical reference tool for hospitals, emergency departments, clinics, pediatric group practices, transport services, and medical schools, is now available from EBSCOHealth. Designed by pediatricians, emergency physicians and other medical specialists, the vast content in PEMSoft addresses the entire spectrum of neonatal, infant, child, adolescent and young adult health. PEMSoft authors adhere to a strict evidence-based editorial policy focused on systematic identification, evaluation and consolidation of practice-changing clinical literature.

The PEMSoft Mobile app includes explicit step-by-step emergency critical care procedures, information about common pediatric signs and symptoms and content covering pediatric injuries and management approaches. More than 3,000 evidence-based pediatric topics and a similar number of medical illustrations, clinical images and videos are also available via the mobile app.

The PEMSoft Mobile App is accessible from both Apple and Android devices. Visit the PEMSoft page for more information.

DynaMed Contribution Opportunities

Become a DynaMed Resident Focus Reviewer
DynaMed Peer Review
Editorial Policies for Reviewers
Education for Clinicians in Training

Call for Peer Reviews

We are currently seeking subspecialty reviewers for our Patient Education Resource Center (PERC). PERC provides fact sheets and discharge instructions for patients leaving the hospital or emergency room. These hand-outs fulfill the meaningful use requirements for the Medicare & Medicare Services Incentive Programs.

Click here to speak with us about becoming a peer reviewer.