Agonising arthritis left Susan, 67, struggling to walk, but this drug-free therapy helped her ditch painkillers – and avoid knee and hip replacement

A few years ago, Susan Harrison’s joints were causing her so much pain that she felt hip and knee replacement operations would soon be inevitable.

Susan, 67, had been diagnosed with osteoarthritis – ‘wear-and-tear’ arthritis, where the cushioning cartilage becomes worn down, so bone rubs on bone – in both hips and in her left knee in 2022.

‘I was keen to push through the pain to keep walking every day, but I had to change where I walked to avoid stepping on to high footpaths or getting up and over stiles in the fields, which both caused pain in my hips,’ says Susan, a retired council electoral services manager, who lives with husband David, 69, near Clitheroe in Lancashire.

‘The pain could be intense, causing severe aching joints and throbbing sensations at times.’

Despite her determination to carry on as normal, within months she was waking up multiple times a night, needing painkillers and even getting up the stairs was painful.

‘Waking up so often and finding it difficult to get back to sleep really impacted my days,’ adds Susan, a grandmother of six.

‘I’d fall asleep watching TV and often had to have a nap after lunch if I was particularly exhausted.’

Fast-forward four years and she can take stairs with ease, enjoys lengthy daily walks and rarely needs painkillers.

And although she may ultimately need joint replacement surgery, it is something she hopes to now avoid for many years.

What helped? Susan is convinced the answer was acupuncture.

Within three weeks of starting 75-minute sessions weekly, Susan says: ‘I could walk up the stairs normally and walking around my village was easier.’

Acupuncture, which involves inserting fine needles into specific points on the body, has been used for centuries in China and is already available under some circumstances on the NHS. These tend to be for chronic pain conditions such as fibromyalgia, which causes widespread pain throughout the body, and migraines. (It is, however, normally restricted to a maximum of ten sessions).

Western acupuncture uses fewer needles inserted less deeply than the ancient Chinese version and into ‘acupuncture points’ known to have a greater number of nerve fibres, rather than those connected with energy and blood flow.

And some studies suggest it can be very effective for pain.

For example, when patients with knee arthritis were given ‘electro’ acupuncture (where needles are inserted and a small electrical current is passed through them, supposedly to enhance the effects) three times a week for six weeks – they showed ‘significantly’ better improvement in scores for pain and stiffness, compared to those given a sham therapy, according to a study in eClinicalMedicine, published by The Lancet, in June this year.

What’s more, follow-up MRI scans suggested the ‘electro’ acupuncture might have ‘anti-inflammatory and cartilage-protective effects,’ researchers said.

New research also points to benefits beyond pain – acupuncture may even help with depression and anxiety. In a review of seven studies, published in the journal Medicine in August, scientists at the Beijing University of Chinese Medicine analysed brain scans from around 350 people with depression who were also taking antidepressants.

They found that those undergoing acupuncture had increased activity in areas of the brain associated with mood control, compared with those only on antidepressants.

Furthermore, acupuncture was also more effective than antidepressants alone at reducing depression and anxiety scores reported by the participants.

Exactly how acupuncture triggers health benefits is not known for sure, but there are several theories for its effects.

Firstly, it prompts the release of a chemical (called adenosine) that can ‘turn off’ pain signals in the tissue around the needle site, reducing inflammation in that area, explains Dr John Hughes, head of research at the Royal London Hospital for Integrated Medicine, part of University College London Hospitals NHS Foundation Trust.

On top of that, the needles are thought to stimulate ‘sensory nerve fibres that send signals to the spinal cord and brain to release endorphins – also known as “happy hormones” – which are the body’s natural painkiller’, he adds.

The increase in these happy hormones could explain why acupuncture helps in depression.

Acupuncture also triggers the release of the stress hormone cortisol, which at high levels can drive inflammation, but in the short term acts as a natural anti-inflammatory – possibly explaining why it’s helpful for people with arthritis and other inflammatory conditions, explains Dr Hughes.

What’s more, people undergoing acupuncture often believe it will work and that may activate placebo processes in the brain, which trigger the release of naturally occurring pain-relieving opioids in the brain, adds Dr Kirsty Bannister, a pain neuroscientist and an associate professor of sensory neurophysiology at Imperial College London.

‘This – together with the proven anti-inflammatory and pain-relieving effects – mean acupuncture may reduce pain,’ she says.

According to the National Institute for Health and Care Excellence (NICE) – the treatment watchdog – acupuncture is recommended ‘where there is evidence it can help certain groups of patients… for example, in the management of chronic pain’.

The criteria are strict and it won’t cover people with arthritis, lower back pain or cancer-related pain, who must instead pay for it privately. A single session can cost up to £150 in London.

One reason it’s not recommended more widely is due to a lack of UK research; most acupuncture studies are conducted in China, says Ian Appleyard, research and policy manager at the British Acupuncture Council.

‘In China people are more used to it, and are better able to lie there and have stronger stimulation from turning the needles – whereas it takes many Westerners more time to be comfortable with it,’ he says.

‘We have to show it works on the British population to change NHS guidance.’

One problem in acupuncture trials is ‘sham’ acupuncture – which is given to some in a study group as a control to compare the results against – isn’t what we think of as sham, as ‘you’re still inserting a needle’, says Dr Bannister.

‘NICE will not recommend something unless it shows a certain level of improvement over a placebo – and usually acupuncture doesn’t reach that threshold compared with sham acupuncture, because the sham itself is an active treatment and can still stimulate the nerves to an extent,’ adds Ian Appleyard.

Acupuncture is generally regarded as low risk in trained hands (only a few people, those who are pregnant, for instance, may not be suitable) – however, it isn’t a cure, says Dr Bannister.

‘Acupuncture might relieve symptoms, but it does not target the underlying cause of any disease,’ she says.

‘Stopping medications such as antidepressants or drugs that suppress the immune system [given for some forms of arthritis] in favour of acupuncture would be dangerous.’

However, for those like Susan who are keen to avoid taking painkillers, acupuncture can appear an attractive option.

She was upset when an X-ray in 2022 revealed she had such widespread osteoarthritis.

‘Reading about the condition, I was concerned that my quality of life could potentially be severely impaired,’ explains Susan.

‘I was told it wasn’t bad enough yet for me to have joint replacements and I needed to live with it. But I wondered if I’d need joint replacement operations and worried how long they’d last, if so.’

She was advised to take painkillers and given daily exercises, such as leg raises, to improve strength and mobility.

‘I don’t like taking painkillers unless I really need them but knew things would only deteriorate,’ says Susan.

Soon the pain had worsened – to the point where her sleep was so disturbed that she often needed to take painkillers multiple times through the night; her hips would throb when going upstairs; and her knee would swell up by the end of the day.

‘With no cure for osteoarthritis, I wanted to find a different way to manage the condition and prevent surgery,’ says Susan.

Decades before, she’d found acupuncture had helped with tennis elbow. So in August 2023, she decided to try it for her hips and knee.

As acupuncture isn’t regulated in the UK, the quality of practitioners can vary.

‘Most acupuncture clinics are privately run so anyone can set up their own organisation without qualifications,’ explains Ian Appleyard. (To find a qualified practitioner, check they are listed on the British Acupuncture Council website.)

In future, there may be a DIY solution.

A team led by Dr Hughes at University College London recently completed an initial trial to assess whether cancer patients having chemotherapy could safely administer needles in their lower legs.

The 40 patients in the trial found they could easily give themselves the treatment and found their cancer symptoms and the side-effects of their treatments – which included pain, nausea and poor sleep – improved.

Susan currently has acupuncture once every five or six weeks for maintenance, for which she pays £60 a session.

‘Acupuncture has made a huge difference to me – it’s given me a new lease of life,’ says Susan.

‘While it’s not a cure and I do get symptoms sometimes, it’s not nearly as bad as it was and I can’t remember the last time I needed painkillers.

‘I can walk in a more fluid way rather than feeling so stiff, and I’m able to enjoy being active again.

‘I feel much better knowing I can manage the condition with acupuncture, and that hopefully I can avoid joint replacements – although if my pain levels get worse then I’ll see my GP again.

‘I’d recommend acupuncture to anyone.’