{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T11:55:52Z","timestamp":1791374152888,"version":"4.3.1"},"reference-count":30,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T00:00:00Z","timestamp":1791331200000},"content-version":"vor","delay-in-days":279,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["82474619"],"award-info":[{"award-number":["82474619"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100017950","name":"Shanghai Municipal Health Commission","doi-asserted-by":"publisher","award":["ZY(2025-2027)-3-2-1"],"award-info":[{"award-number":["ZY(2025-2027)-3-2-1"]}],"id":[{"id":"10.13039\/100017950","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pain Research and Management"],"published-print":{"date-parts":[[2026,1]]},"abstract":"\n Background<\/jats:title>\n Knee osteoarthritis (KOA) is a common chronic degenerative joint disease. Its rising incidence, driven by population aging and increasing obesity rates, imposes a growing socioeconomic burden. As a therapy integrating the dual merits of acupuncture regulation and thermal stimulation, warm acupuncture has been widely adopted for KOA, accompanied by a growing body of relevant research. However, standardized recommendations regarding optimal treatment frequency and course duration of warm needle acupuncture for KOA remain lacking.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n A total of 84 eligible KOA patients were enrolled and randomly assigned to either a high\u2010frequency group or a low\u2010frequency group. The high\u2010frequency group received 5 treatments per week for the first 2\u2009weeks, whereas the low\u2010frequency group received 2 treatments per week during the same period. The primary outcome was the between\u2010group difference in the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain score at the end of Week 2. Secondary outcomes included the WOMAC stiffness and function scores, active range of motion of the knee joint, medical infrared thermography data, quantitative scoring of traditional Chinese medicine (TCM) syndrome classification, and the Patient Health Questionnaire\u20109 (PHQ\u20109). Analyses were performed using generalized estimating equations.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n The WOMAC pain score in the high\u2010frequency group after 2\u2009weeks of treatment showed a statistically significant difference compared to the low\u2010frequency group (difference, 3.07 [95% CI, 1.86 to 4.28],\n p<\/jats:italic>\n \u2009<\u20090.001). Secondary outcome results indicated that acupuncture, compared to the low\u2010frequency group, significantly alleviated the WOMAC stiffness score (difference, 0.90 [95% CI, 0.26 to 1.55],\n p<\/jats:italic>\n = 0.006) and WOMAC functional scores (difference, 6.86 [95% CI, 2.58 to 11.13],\n p<\/jats:italic>\n = 0.002), as well as active knee range of motion (difference, \u221211.00 [95% CI, \u221216.31 to \u22125.69],\n p<\/jats:italic>\n < 0.001) and the quantified score for traditional Chinese medicine syndrome grading (difference, 1.71, 95% CI, 0.88 to 2.55,\n p<\/jats:italic>\n < 0.001). However, no statistically significant differences were observed in the PHQ\u20109 total score or knee\u2010related regional temperature (\n p<\/jats:italic>\n \u2009>\u20090.05). The incidence of adverse events was similar between the two groups.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n Both high\u2010 and low\u2010frequency warm acupuncture significantly improved clinical symptoms in patients with KOA. However, high\u2010frequency warm acupuncture demonstrated markedly superior efficacy compared to low\u2010frequency treatment in alleviating pain, enhancing joint function, increasing active knee range of motion, and improving TCM syndromes. These findings provide evidence\u2010based support for optimizing treatment frequency in warm needle acupuncture as a safe and effective non\u2010pharmacological intervention for KOA.<\/jats:p>\n \n Trial Registration:<\/jats:bold>\n International Traditional Medicine Clinical Trial Registry: ITMCTR2024000269\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1155\/prm\/1674261","type":"journal-article","created":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T11:33:01Z","timestamp":1791372781000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Frequency\u2010Dependent Effects of Warm Needle Acupuncture in Patients With Knee Osteoarthritis With Cold\u2010Dampness Obstruction Syndrome: A Randomized Controlled Trial"],"prefix":"10.1155","volume":"2026","author":[{"ORCID":"https:\/\/orcid.org\/0009-0002-5203-8548","authenticated-orcid":false,"given":"Hanzhi","family":"Deng","sequence":"first","affiliation":[{"name":"Shanghai Municipal Hospital of Traditional Chinese Medicine Shanghai University of Traditional Chinese Medicine Shanghai 200071 China shutcm.edu.cn"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-3875-4329","authenticated-orcid":false,"given":"Qin","family":"Su","sequence":"additional","affiliation":[{"name":"Shanghai Municipal Hospital of Traditional Chinese Medicine Shanghai University of Traditional Chinese Medicine Shanghai 200071 China shutcm.edu.cn"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-6593-5544","authenticated-orcid":false,"given":"Yuqing","family":"Wang","sequence":"additional","affiliation":[{"name":"Shanghai Municipal Hospital of Traditional Chinese Medicine Shanghai University of Traditional Chinese Medicine Shanghai 200071 China shutcm.edu.cn"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1696-4264","authenticated-orcid":false,"given":"Jiqing","family":"Wang","sequence":"additional","affiliation":[{"name":"Shanghai Municipal Hospital of Traditional Chinese Medicine Shanghai University of Traditional Chinese Medicine Shanghai 200071 China shutcm.edu.cn"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-3730-7020","authenticated-orcid":false,"given":"Kai","family":"Liu","sequence":"additional","affiliation":[{"name":"Shanghai Municipal Hospital of Traditional Chinese Medicine Shanghai University of Traditional Chinese Medicine Shanghai 200071 China shutcm.edu.cn"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7006-2237","authenticated-orcid":false,"given":"Liying","family":"Fu","sequence":"additional","affiliation":[{"name":"Shanghai Municipal Hospital of Traditional Chinese Medicine Shanghai University of Traditional Chinese Medicine Shanghai 200071 China shutcm.edu.cn"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5466-2152","authenticated-orcid":false,"given":"Shanshan","family":"Li","sequence":"additional","affiliation":[{"name":"Shanghai Municipal Hospital of Traditional Chinese Medicine Shanghai University of Traditional Chinese Medicine Shanghai 200071 China shutcm.edu.cn"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5595-3480","authenticated-orcid":false,"given":"Shifen","family":"Xu","sequence":"additional","affiliation":[{"name":"Shanghai Municipal Hospital of Traditional Chinese Medicine Shanghai University of Traditional Chinese Medicine Shanghai 200071 China shutcm.edu.cn"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1977-3631","authenticated-orcid":false,"given":"Yiqun","family":"Mi","sequence":"additional","affiliation":[{"name":"Shanghai Municipal Hospital of Traditional Chinese Medicine Shanghai University of Traditional Chinese Medicine Shanghai 200071 China 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Acupuncture and Moxibustion"},{"key":"e_1_2_19_13_2","first-page":"705","article-title":"Guidelines for Diagnosis and Treatment of Osteoarthritis (2018 Edition)","volume":"38","author":"Osteoarthritis Group of Chinese Orthopaedic Association","year":"2018","journal-title":"Chinese Journal of Orthopaedics"},{"key":"e_1_2_19_14_2","first-page":"929","article-title":"Guidelines for Treatment of Osteoarthritis Basing on the Integration of Diagnosis and Syndrome Differentiation (In Chinese)","volume":"36","author":"Rheumatology Branch of China Association of Chinese Medicine","year":"2021","journal-title":"China Journal of Traditional Chinese Medicine and Pharmacy"},{"key":"e_1_2_19_15_2","first-page":"457","article-title":"Warm Acupuncture for Knee Osteoarthritis: A Randomized Controlled Trial","volume":"37","author":"Wang X.","year":"2017","journal-title":"Chinese Journal of Acupuncture and Moxibustion"},{"key":"e_1_2_19_16_2","doi-asserted-by":"publisher","DOI":"10.3399\/BJGP.2020.0797"},{"key":"e_1_2_19_17_2","doi-asserted-by":"publisher","DOI":"10.1186\/s13643-025-02762-x"},{"key":"e_1_2_19_18_2","first-page":"799","article-title":"Warming Acupuncture Combined With Moxibustion at Yongquan (KI 1) for Knee Osteoarthritis With Kidney-Marrow Deficiency: A Randomized Controlled Trial","volume":"39","author":"Liu S. R.","year":"2019","journal-title":"Zhongguo Zhen jiu = Chinese Acupuncture & Moxibustion"},{"key":"e_1_2_19_19_2","first-page":"1409","article-title":"Clinical Study on Different Moxibustion Methods for Treating Knee Osteoarthritis","volume":"44","author":"Chen G.","year":"2025","journal-title":"Shanghai Journal of Acupuncture and Moxibustion"},{"key":"e_1_2_19_20_2","first-page":"1","article-title":"Effects of Warm-Needle-Moxibustion at Neixiyan (EX-LE4) and Waixiyan (EX-LE5) on the Expression of Caspase-3 and Caspase-9 mRNA in Knee Cartilage of Rabbits With Knee Osteoarthritis","volume":"40","author":"Wang J.","year":"2017","journal-title":"Journal of Yunnan University of Traditional Chinese Medicine"},{"key":"e_1_2_19_21_2","first-page":"48","article-title":"Based on NF-\u03baB Signaling Pathway, The Mechanism of Heat-Sensitive Moxibustion in the Treatment of Knee Osteoarthritis Rabbit Model was Discussed","volume":"48","author":"Zhang H. F.","year":"2017","journal-title":"Jiangxi University of Traditional Chinese Medicine"},{"key":"e_1_2_19_22_2","first-page":"56","article-title":"Re-Evaluation of Systematic Reviews on Moxibustion Treatment for Knee Osteoarthritis","volume":"31","author":"Wang Z.","year":"2024","journal-title":"Journal of Chinese Medicine and Pharmacy"},{"key":"e_1_2_19_23_2","first-page":"1452","article-title":"Therapeutic Observation of Needle Warming Moxibustion for Mild-to-Moderate Knee Osteoarthritis and Its Effect on TLR4\/NF-\u03baB Signaling Pathway","volume":"40","author":"Sun G. F.","year":"2021","journal-title":"Shanghai Journal of Acupuncture and Moxibustion"},{"key":"e_1_2_19_24_2","first-page":"108","article-title":"Research Progress on the Analgesic Mechanism of Warm Acupuncture in Early-to-Mid-Stage Knee Osteoarthritis","volume":"14","author":"Yi Li","year":"2022","journal-title":"Chinese Journal of Clinical Medicine"},{"key":"e_1_2_19_25_2","first-page":"1","article-title":"Based on TLR-4\/MyD88\/NF-\u03baB Signal Pathway, This Paper Explores the Mechanism of Warm Acupuncture Intervention in Rabbits With Knee Osteoarthritis","author":"Wang S. D.","year":"2026","journal-title":"Chinese Archives of Traditional Chinese Medicine"},{"key":"e_1_2_19_26_2","first-page":"105","article-title":"Effects of Warm Acupuncture on Cartilage Cell Apoptosis and MiR-27a-Mediated PI3K\/AKT\/mTOR Signaling Pathway in Rats With Knee Osteoarthritis","volume":"46","author":"Wu F.","year":"2024","journal-title":"Chinese Journal of Physical Medicine and Rehabilitation"},{"key":"e_1_2_19_27_2","doi-asserted-by":"publisher","DOI":"10.1097\/j.pain.0000000000001940"},{"key":"e_1_2_19_28_2","first-page":"1442","article-title":"Effect and Safety Evaluation of Different Frequency of Fire Needling on Knee Osteoarthritis With Cold Dampness Obstruction Syndrome: A Randomize-Controlled Clinical Trial","volume":"63","author":"Guo Y.","year":"2022","journal-title":"Journal of Traditional Chinese Medicine"},{"key":"e_1_2_19_29_2","first-page":"128","article-title":"Analysis of Rehabilitation Outcomes in Patients After Shoulder Joint Adhesion Release Surgery Based on Different Functional Exercise Frequencies","volume":"40","author":"Wang C.","year":"2021","journal-title":"Chinese and Foreign Medicine"},{"key":"e_1_2_19_30_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12891-024-07191-w"}],"container-title":["Pain Research and Management"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1155\/prm\/1674261","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1155\/prm\/1674261","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1155\/prm\/1674261","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T11:33:07Z","timestamp":1791372787000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1155\/prm\/1674261"}},"subtitle":[],"editor":[{"given":"Suraiya","family":"Saleem","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2026,1]]},"references-count":30,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2026,1]]}},"alternative-id":["10.1155\/prm\/1674261"],"URL":"https:\/\/doi.org\/10.1155\/prm\/1674261","archive":["Portico"],"relation":{},"ISSN":["1203-6765","1918-1523"],"issn-type":[{"value":"1203-6765","type":"print"},{"value":"1918-1523","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1]]},"assertion":[{"value":"2026-04-01","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-09-01","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-10-07","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"1674261"}}