Comprehensive Overview: Acupuncture for Pain Relief in Emergency Departments

Introduction

A study published in the Medical Journal of Australia explored how effective acupuncture is for pain relief in emergency departments. Researchers aimed to see how acupuncture alone, acupuncture combined with medication, and medication alone compared in treating acute low back pain, migraines, and ankle sprains.

Objectives

The primary aim was to determine if acupuncture alone or in combination with medication could provide pain relief comparable to medication alone within one hour. Secondary objectives were to assess safety, patient acceptability, impact on functionality, and use of health resources.

Methods

• Study Design: This was a pragmatic, multicentre, randomised, assessor-blinded trial.
• Participants: 528 patients from four hospitals in Melbourne participated. They had acute low back pain, migraines, or ankle sprains with a pain score of at least 4 on a 10-point scale.
• Treatments: Patients were randomly assigned to one of three groups: acupuncture alone, acupuncture with medication, or medication alone.
  • Acupuncture alone: Performed by registered Chinese medicine practitioners or ED physicians with acupuncture qualifications.
  • Medication alone: Administered based on national guidelines, including first and second-line drugs.
  • Combined treatment: Both acupuncture and medication, with acupuncture given 15 minutes before or after medication to maintain blinding.
• Measurements: Pain levels were recorded at the start (T0), one hour after treatment (T1), and during follow-up.

Results

• Participants: Of 1964 patients assessed, 528 were included. Groups were well-matched in demographics and initial pain levels: 270 had low back pain, 92 had migraines, and 166 had ankle sprains.
• Pain Relief: At T1, there was no significant difference in pain relief among the groups. Only 16% had clinically significant pain relief (score below 4), and 36.9% had a statistically significant reduction (more than 2 points).
• Safety and Acceptability: Acupuncture was as safe and acceptable as medication. Patients receiving acupuncture were more likely to need additional pain relief. Satisfaction and willingness to repeat treatment were high across all groups, slightly increasing for acupuncture over time.
• Health Resource Use: No significant differences were found in length of stay in the emergency department or hospital, admission rates, or other resource uses between groups.

Discussion

The study concluded that acupuncture is a viable, safe, and acceptable option for pain relief in emergency departments. However, none of the treatment strategies, including acupuncture, medication, or their combination, provided optimal pain relief within the first hour. This suggests a need for more effective pain management options in emergency settings.

Conclusion

Acupuncture offers comparable pain relief to medication for acute low back pain and ankle sprains in emergency departments. Despite being safe and acceptable, more effective pain management strategies are needed as none of the treatments provided optimal relief within one hour.

Implications

The results suggest that while acupuncture can be integrated into emergency pain management, there is still a need for more comprehensive pain relief solutions. This could include developing new protocols or combining treatments more effectively.

References

Cohen MM, Smit DV, Andrianopoulos N, et al. Acupuncture for analgesia in the emergency department: a multicentre, randomised, equivalence and non-inferiority trial. Med J Aust. 2017;206(11):494-499. doi:10.5694/mja16.00771