Electronic stimulation (e-stim), has shown to increase the efficacy of acupuncture treatment for knee pain.
The following randomized control study (RCS / RCT randomized control trial), shows that e-stim out performed transcutaneous electrical nerve stimulation (TENS) in treating knee pain from osteoarthritis (OA).
1 Both EA and TENS treatments were effective in reducing OA-induced knee pain. EA had the additional advantage of enhancing the TUGT results as opposed to TENS treatment or no treatment, which did not produce such corollary effect.
The Timed Up and Go Test (TUG) is used to measure a patient’s risk of falling and ability to go from sitting to standing and walking.
A randomized controlled trial (RCT), consisting of 32 patients, split into four groups: acupuncture, tens (trans cutaneous electrical nerve stimulation), acupuncture & TENS, and a control group receiving only a topical application, received treatment once a week for five weeks. The results of the RCT showed that the acupuncture and TENS group had the lowest visual analogue scale (VAS) scores at the 10th week follow up session.
2 These results suggest that acupuncture and TENS treatments have positive effects on the quality of life (QOL) of the knee OA patients, and that A&T treatment was significantly more effective in terms of WOMAC scores than other treatments
Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC)
A study proposing the protocol for RCT’ suggest the hypothalamic-pituitary-adrenal (HPA) axis and the endogenous opioid (EO) system, are pathways that acupuncture and e-stim affect to reduce pain in OA. Also, as stated in previous post, a combination of different modalities is recommended for treatment of OA.
3 The most recent clinical guidelines based upon evidence from the UK National Institute of Clinical Excellence  and the Osteoarthritis Research International (OARSI) suggest that the treatment for OA be multidisciplinary in nature and consider non-pharmacological treatment (such as education, aerobic and resistance exercises, and weight loss) as well as pharmacological treatment options (paracetamol) when an additional treatment is required.
If you’re concerned whether this combination of acupuncture and e-stim is appropriate for knees with metal implants, from total knee replacement (TKR) or anterior cruciate ligament (ACL), it is. I use it on myself regularly and I’ve had ACL repair in both knees.